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2. Farmington Police Department Alarm User Registration Form
4. Name of User:*
   Name of Business, if residence, name of two adults
6. Person in Control:*
8. Date of Birth (User):
   First Adult
9. Date of Birth (Person In Control):
   Second Adult
11. Alarm Location*

    1. Residence

    1. Business

    1. Financial

    1. Government
13. If Residence

    1. House

    1. Condominium

    1. Apartment

    1. Other
14. If Business, type of Business:
16. Street Address*
18. Nearest Cross Street
20. City*
21. State*
22. Zip*
24. Main Phone
25. Phone (#1 A)
26. Phone (#1 B)
28. Mailing Address, if different from Street Address
30. System Information*

    1. New System
31. Installation Date
    Installation Date
32. System Information

    1. Existing System
33. Installation Date
    Installation Date
35. Type of Burglary Alarm System (check only one):*

    1. Audible Only (system sounds a siren/bell only)

    1. Monitored Only (system signals alarm company only)

    1. Both Audible and Monitor
37. Type of Burglary Alarm System (check only one)

    1. Audible Only (system sounds a siren/bell)
    2. Monitored Only (system signals alarm company only)
    3. Both Audible and Monitored
39. Name of Alarm Monitoring Company:
40. 24 Hour Telephone:
42. Name of Installation/Service Company:
43. 24 Hour Telephone:
45. Type of User Activated Alarms:*

    1. Robbery/Holdup (a silent signal only is sent to the alarm company)

    1. Panic (a silent/bell sounds at the location and a silent signal is also sent to the alarm company)

    Check appropriate box(s) if a user of the alarm system can activate these special emergency conditions even when the burglar alarms system protecting the premises is turned off.
47. Type of Other Emergency Signals:

    1. Fire Alarm

    1. Medical Alert
49. List two people other than user and person in control who can be contacted with keys to the premises to assist police and/or fire to secure the premises or reset a malfunctioning alarm (must list two)
51. Name:*
52. Address
54. Date of Birth
55. Phone
56. Alternate Phone
58. Name:*
59. Address
61. Date of Birth
62. Home Phone
63. Alternate Phone
65. Instructions to help officers respond/search your premises (example: directions, guard dog, etc.):
67. Authorized Electronic Signature:*
68. Date:*
Leave This Blank:


70. 1. Receive an email copy of this form.
71. Email address

    This field is not part of the form submission.

72. Submit

* indicates a required field