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2. COLCHESTER POLICE ALARM REGISTRATION - Residential
4. First Name*
5. Last Name*
7. Date of Birth*
9. ALARMED PROPERTY INFORMATION:
11. Address*
13. Property Phone Number*
15. HOME OWNER CONTACT INFORMATION:
17. Cell
18. Work
20. Email*
22. IF MAILING ADDRESS IS NOT THE ALARMED ADDRESS, PLEASE COMPLETE THE FOLLOWING:
24. Street Name
26. City
27. State
28. Zip Code
30. CONTACT INFORMATION:
32. LIST THREE INDIVIDUALS WHO YOU WOULD LIKE US TO NOTIFY IN CASE OF AN EMERGENCY INVOLVING YOUR RESIDENCE.
34. Contact # 1*
35. Home Phone Number
37. Cell Phone Number
38. Work Phone Number
40. Has key to residence?

    1. Yes

    1. No
44. Contact # 2
45. Home Phone Number
47. Cell Phone Number
48. Work Phone Number
50. Has key to residence?

    1. Yes

    1. No
54. Contact # 3
55. Home Phone Number
57. Work Phone Number
58. Cell Phone Number
60. Has key to residence?

    1. Yes

    1. No
62. ALARM MONITORING COMPANY INFORMATION:
64. Select One*
    -- Select One --ADTCentra-larmDieboldFederated Fire / SecurityHome SecurityInterfaceLifelineLive WatchMetro DialMonitronicsNortheastern SecurityProperty ProtectionProtection 1Rapid ResponseRound Hill SecuritySentinelStanley SecuritySummitTyco IntegratedXfinty / ComcastOther***
65. 24 Hour Phone Number
67. IF OTHER PLEASE LIST HERE***
68. Phone Number
70. ACKNOWLEDGEMENT:
72. 
74. 
76. Please check the box*

    1. I acknowledge that I have read the Colchester Police alarm registration ordinance
78. Please enter in your initals *
80. POLICE USE ONLY

    1. E-M
    2. E-List

    1. Wave
    2. SS

    1. Valcour
    2. Paid
Leave This Blank:


82. 1. Receive an email copy of this form.
83. Email address

    This field is not part of the form submission.

84. Submit Submit and Print

* indicates a required field