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Get City Of Fairfield Alarm Registration Form

Account CITY OF FAIRFIELD 1000 Webster St. Fairfield CA 94533 Alarm Registration Form INSTRUCTIONS Print legibly or type. Complete all application items. Complete a separate application for each address to be permitted* Attach payment and return to the address shown at the bottom of this form 1 Alarmed Location LastName FirstName email Occupant Name or Business Name Suite/Apt Full Street Address City State Home/Business Phone Zip 2 Billing Address If different than Alarmed Location Work/Cell Phone Home Work Name Cell 3 Contact Names Individual s /Keyholder able to respond to Alarm Site location Contact 1 Wk/Cell 4 Additional Information Special Conditions/ Hazards 5 Monitored By Not Monitored Alarm Company Name Street Address Alarm Co Phone I understand that in accordance with City Code 2006-09 Section 10C. 5 b and 10C. 7 a applicant is financially responsible for all charges and penalties specific in this section* Signature Date NOTE If information provided in application changes you must notify the Alarm Administrator within ten 10 working days. Complete all application items. Complete a separate application for each address to be permitted* Attach payment and return to the address shown at the bottom of this form 1 Alarmed Location LastName FirstName email Occupant Name or Business Name Suite/Apt Full Street Address City State Home/Business Phone Zip 2 Billing Address If different than Alarmed Location Work/Cell Phone Home Work Name Cell 3 Contact Names Individual s /Keyholder able to respond to Alarm Site location Contact 1 Wk/Cell 4 Additional Information Special Conditions/ Hazards 5 Monitored By Not Monitored Alarm Company Name Street Address Alarm Co Phone I understand that in accordance with City Code 2006-09 Section 10C. 5 b and 10C. 7 a applicant is financially responsible for all charges and penalties specific in this section* Signature Date NOTE If information provided in application changes you must notify the Alarm Administrator within ten 10 working days.

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