New In Review Zoning Approved Payment Requested Paid Approved Issued Denied Expired Renewed

No Yes

New Renewal Location Change

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

Own Lease

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Phone # *

Name *

Vending Machine(s)

Type of Sign

Address *

Boat Slips

Central Station

Email

Does alarm reset itself?

Emergency Contact Details (Up to 3, 1 Required)

Email *

Fire

Last Name

Block

***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.***

Pinball Machine(s)

Multi-Room Cabins or Trailers

If "Lease", length of lease?

First Name

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

Tennis/Squash Courts

Alarm Company Information

Ice Machines

Business Location

Application Type *

Rooms (Hotels/Motels)

Email

Is alarm audible?

Will You Be Installing a Sign? *

Address *

Seats (Restaurant)

Address 2

If “Yes”, state the previous business (if known)

Phone #

Own or Lease the building? *

Last Name *

Size of the Sign (SQFT)

City, State, ZIP *

Panic/Hold-up

Temperature

Supervisor Name *

Was the Property Previously Occupied? *

Title *

Business Name *

Attach your documents

Title

Email *

Email

Phone # *

Phone Number

Lot

Last Name

Building Owner Details

Flood

Installation Company

State *

Other

Burglary

Washers/Dryers

Phone Number

Phone # *

Last Name *

I (we) hereby certify that I (we) have read this application thoroughly and the information contained herein is true and accurate.

Mercantile Registration Ecode.

Baths, Saunas, Pools

The following Application Fee shall apply to this Business Type

Phone # *

Business Type *

Address *

Certification

Types of Alarms Monitored (Select all that apply)

Title

Single Room Cabins or Trailers

Other Business Details

Applicant Signature *

If you have any of the following, please select and list how many:

Business Owner Details

First Name *

Description of Business *

First Name *

City *

Gas Pumps

Attach any relevant documents.
Restaurants must attach their County Board of Health Certificate.

Title

Auto. Slot Machines, Video Games, Pool Table, Music, etc.

Email *

ZIP *

Medical

Phone #

First Name