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Yes
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Own
Lease
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No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
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Yes
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Yes
No
Yes
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Yes
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Yes
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Single Family
Duplex
Multi-Family
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Passed
Failed
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Type Full Name :
Sign With Hand
Clear
Done
Phone #
*
Name
*
Vending Machine(s)
{[CNAME]}
{[ADDR]}
{[CITY]}, {[STATE]} {[ZIP]}
{[APHONE]}
{[AWEBSITE]}
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/Handball/Paddleball Courts
Alarm Company Information
Ice Machines
Business Location
Application Type
*
Rooms (Hotels/Motels)
Email
No of units
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)
Block Lot
City, State, ZIP
*
Panic/Hold-up
Inspection Date and Time
Temperature
Supervisor Name
*
Inspection Results
Was the Property Previously Occupied?
*
Bowling Alleys
Owner name
Reason for failure
Title
*
Business Name
*
Attach your documents
Title
Email
*
Email
Phone #
*
Phone Number
Lot
Last Name
Building Owner Details
Flood
Installation Company
Property address
State
*
Other
Movie Theater Projectors
Electrical Transmissions
Burglary
Washers/Dryers/Laundromat
Phone Number
Taxi Cabs
Phone #
*
Lock Box code
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 number
Phone #
*
Business Type
*
Address
*
Rental Email
Certification
Types of Alarms Monitored (Select all that apply)
Garages & Parking Lots
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
Present use of property
First Name
*
Description of Business
*
Building occupied
First Name
*
City
*
Gas Pumps
Attach any relevant documents.
Restaurants must attach their County Board of Health Certificate. Please upload attachments as PDF, JPG, or JPEG
Short-Term Rental
Title
Auto. Slot Machines, Video Games, Pool Table, Music, etc.
Email
*
ZIP
*
Medical
{[PNAME]}
Phone #
First Name
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Reference Number:
Date Submitted:
Business Name:
Fee:
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Reference Number
Business Owner First Name
Business Owner Email
Business Name