Type Full Name :
Sign With Hand
Last Name *
Phone # *
Name *
Alarm Company Information
{[CITY]}, {[STATE]} {[ZIP]}
First Name
Address *
# of Employees *
Email *
Block *
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.
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
Any changes from previous mercantile use? *
Address *
Address 2
# of Exits *
Types of Alarms Monitored (Select all that apply)
Own or Lease the building? *
Mailing City, State, ZIP *
Require Sprinklers? *
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 *
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? *
Date of Last Fire Inspection *
How long will alarm sound before resetting? (Time in Minutes)
Attach your documents
Supervisor City State ZIP *
Other Business Details
Applicant Signature *
Business Owner / Applicant Details
Date of Last Health Inspection *
Supervisor Address *
# of Parking Spaces *
Business Description *
First Name *
City *
Registered Agent Address *
Phone Number
Phone #
Square Feet *
Email *
Nature of Business *
Status of Last Fire Inspection *