New Renewal Location Change

Sole Proprietorship Corporation Partnership LLC None - Applicant Only

AL AK AZ AR CA CO CT DE FL HI ID IL IA KS KY ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY AS DC FM GU MH MP PW PR VI GA

Yes No

Yes No

Yes No

Yes No

Yes No

Own Lease

Yes No

Yes No

Last Name *

Phone # *

Name *

Alarm Company Information

First Name

Address *

# of Employees *

Email *

Block *

Title

If so, length of lease

***Payment will NOT be requested until your application has been approved & accepted.***
Please monitor your e-mail for the Payment Request e-mail.
***Please DO NOT SUBMIT DUPLICATE REQUESTS.***

Title

Central Station

Occupancy Load *

City *

Attach any of the following documents. Additional documents may be requested after review.

1. Certificate of Occupancy
2. Copy of certificate or license issued by State of New Jersey or any governmental agency.
3. If a corporation, attach copy of Good Standing Certificate.
4. If operation involves any flammable/combustible/hazardous materials: provide MSDS sheets
5. For 501C Organizations: A copy of a valid letter from the IRS verifying the not for profit status and a copy of a current good standing certificate issued by the State of New Jersey

Registered Agent Name *

Involves Flammable/Hazardous Materials? *

Business Details

Type of Ownership *

First Name

Application Type *

Last Name

Medical

Any changes from previous mercantile use? *

Other

Address *

Flood

Address 2

# of Exits *

Types of Alarms Monitored (Select all that apply)

Own or Lease the building? *

Mailing City, State, ZIP *

Require Sprinklers? *

Email

Does alarm reset itself?

Supervisor Name *

Days and Hours of Operation? *

Phone # *

Use the table below to add other Business Owners.
1. If a corporation, give names and addresses of president and secretary
2. If a partnership, give names and addresses of all partners
3. If an LLC, give the name(s) and addresses of the managing member(s)

Status of Last Health Inspection *

Title *

Business Name *

NJ State Tax ID # *

All Real Estate Taxes Paid and Current? *

Lot *

Outstanding Zoning/Planning Violations? *

Emergency Contact Details (Up to 3, 1 Required)

Building Owner / Managing Agent of Property Details

Registered Agent City State ZIP *

Installation Company

State *

Panic/Hold-up

Last Name

State *

Size of Lot *

Federal Tax ID # *

Phone # *

Is alarm audible?

Fee Schedule

Last Name *

I (we) hereby certify that I (we) have read this application thoroughly and the information contained herein is true and accurate. I (we) understand that I (we) may not use or occupy the property until inspections are conducted and both Business Certificate of Occupancy and Zoning Certificate are issued for such use/occupancy.

Business Registration Ecode

First Name *

Zoning Designation

Phone Number

# of Curb Cuts *

Application Fee

Phone # *

Phone #

Address *

501C Non-profit Organization? *

Certification

Date of Last Fire Inspection *

How long will alarm sound before resetting? (Time in Minutes)

ZIP *

Attach your documents

Supervisor City State ZIP *

Email

Other Business Details

Applicant Signature *

Business Owner / Applicant Details

Date of Last Health Inspection *

Supervisor Address *

# of Parking Spaces *

Business Description *

Fire

First Name *

City *

Title

Registered Agent Address *

Email

Phone Number

Phone #

Square Feet *

Burglary

Email *

Nature of Business *

ZIP *

Status of Last Fire Inspection *

Temperature