Applicant Information

Full Name of Business / Occupant / Resident

Alarm Site Address & Apt / Suite

Mailing Address (If Different from Site Address)

City, State, Zip:

 

Is the Alarm for a Residence or Business?:
  Select Residence Business

Check Applicable Type of Alarm:
Holdup     Burglary     Silent     Audible Only     Radio     Cellular Backup     Panic
Other  (Explain:) 

Audible Alarms must reset automatically after a 15-minute annunciation Period.

Type of Alarm Activation Monitoring / Reporting:
Central Station     Dialer     Proprietary

Alarm Company Information

Alarm Company Name:

Address / City / State / Zip:

Phone:

E-mail:

Alarm Company Contact(s):

Does Your Alarm Company Possess a Beavercreek Alarm Company Permit?
  Select Yes No Unknown

ALARM COMPANIES MUST BE LICENSED BY THE CITY OF BEAVERCREEK TO CONDUCT ANY ALARM-RELATED BUSINESS WITHIN BEAVERCREEK.  If not, your alarm company must obtain a Business Alarm License.

Emergency Notification

List names, addresses and telephone numbers of individuals who are able to respond within a reasonable amount of time to an alarm to provide entrance if necessary, reset system and / or secure premises if such need should arise:

 I have read the completed application and represent the same to be true and correct.  I accept responsibility for payment of all fines that may result from the operation on the alarm systems serving the above alarm site.  I will surrender this permit if I transfer ownership of the alarm site Property.  This Permit is non-transferrable.
  Select NO YES