ALARM MONITORING - NEW ACCOUNT SETUP
COMPANY NAME:
FEDERAL ID NUMBER:
CONTACT NAME (FIRST and LAST):
CONTACT EMAIL:
CONTACT PHONE (nnn-nnn-nnnn):

ALARM SYSTEM LOCATION
ADDRESS:
CITY:
STATE:
ZIP:

BILLING LOCATION (If Different)
ADDRESS:
CITY:
STATE:
ZIP:
MAIN PREMISE PHONE NUMBER:
The premise phone numbers are used as the first point of contact after an alarm signal is received. Phone numbers must include the area code.
SECOND  PREMISE PHONE NUMBER:

LOCAL AUTHORITY HAVING JURISDICTION
AGENCY NAME: PHONE (nnn-nnn-nnnn):
POLICE:
FIRE:
MEDICAL:
If you are unsure of the agency serving your address, please contact the local authorities via their non-emergency phone number for verification. NOTE: 911 will not be accepted as a contact number.

EMERGENCY NOTIFICATION LIST

NAME PHONE (nnn-nnn-nnnn): TYPE
Emergency contact numbers will be called, in the order listed, until someone is reached. Multiple numbers may be listed for one individual - place each number on a separate line.

PASSCODE LIST

PASSCODE 1:
Passcodes are used to verify to the monitoring station, that an individual is authorized to be in the protected area. In the event of an intrusion alarm, the central station will first contact the main premise number. If a user has accidently activated the alarm, they provide the passcode to the operator in order to cancel the dispatch of the authorities. Passcodes can be any combination of letters and numbers, up to 12 characters in length. You must have at least one passcode on file.
PASSCODE 2:
PASSCODE 3:
PASSCODE 4: