Section 1 - Alarm Location & Type Information

Alarm Physical Address * Address: City: Zip:

Phone Number at Alarm

Your Mailing Address * Address: City: State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Dist of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip:

Type of Alarm, Check All that Apply: Hold UpIntrusionTroubleFireOther   What Kind of Alarm(s) do you have? Direct ConnectDialerCentral StationAudible

Responder Safety Information: (Hazardous Materials, Fire Arms, Etc.) YesNo If Yes, describe:

Section 2 - Business or Resident Information Business Alarm Information  (If your alarm is located at a business, fill out the next 2 lines)

Business	Business Phone	Business Phone Secondary
Owner/Local Agent Name	Mailing Address	Home Phone

Residential Alarm Information  (If your alarm is located at a residence, fill out the next line)

Resident(s) Name

Contact Numbers

 

Section 3 - Persons to be notified when alarm sounds (We will contact in order shown)

Name	Day Contact Number	Alternate / Cell Number
Name	Day Contact Number	Alternate / Cell Number
Name	Day Contact Number	Alternate / Cell Number
Name	Day Contact Number	Alternate / Cell Number

 

Section 4 - Alarm Company / Central Station Information

Alarm Company Name	Alarm Company Contact
Alarm Company Address	Business Phone	24 hr. Contact Phone
Central Station Company Name (If alarm is central station type)

Section 5 - Owner / Agent Agreement

This application is made by me with the understanding and agreement that I will abide by all provisions of the Lincoln County Alarm Ordinance. I understand that failure to comply may result in termination of my alarm permit, as provided by law.
Initials
By the initials above I certify that the above information is true and accurate to the best of my knowledge.

Permit Number


After submitting this application you will be taken to a form for payment.