PEORIA POLICE DEPARTMENT
RESIDENTIAL ALARM REGISTRATION FORM
(Please PRINT Clearly)


NAME: 									     
DATE: 					

STREET ADDRESS:  	
							
PEORIA, AZ  			
													     (ZIP CODE)
MAILING ADDRESS:  													
(IF DIFFERENT FROM STREET ADDRESS)

HOME TELEPHONE:  (		)     WORK TELEPHONE:  (       	      )				
PAGER NUMBER:      (		)     CELLULAR NUMBER:  (	       )				


()  YES    ()  NO	DO YOU HAVE A VISION OBSCURING DEVICE? 

TYPE OF ALARM:	()    AUDIBLE	()    SILENT	()   BURGLARY
		()   ROBBERY	()   PANIC	()   OTHER  								

ALARM COMPANY: 
 													
ADDRESS:  														

TELEPHONE NUMBER(S):  (		)										

MONITORING ALARM COMPANY:  											

24-HOUR ALARM COMPANY TELEPHONE NUMBER:  (		)							

MISCELLANEOUS INFORMATION:  											
															


1ST PERSON TO NOTIFY IF ALARM IS ACTIVATED 
NAME:  								  	           	      KEYS?     (  YES    (  NO
HOME TELEPHONE:  (	        )	WORK PHONE:  (	           )				
PAGER:  (	  )			CELLULAR:  (	        )					

2ND PERSON TO NOTIFY IF ALARM IS ACTIVATED (OTHER THAN HOMEOWNER)
NAME:  										       

KEYS?     ()  YES    ()  NO

HOME TELEPHONE:  (	        )	WORK PHONE:  (	           )				
PAGER:  (	  )			CELLULAR:  (	        )					


PLEASE RETURN THIS FORM TO:	
PEORIA POLICE DEPARTMENT
ATTENTION:  ALARM COORDINATOR
8351 West Cinnabar Ave.
PEORIA, ARIZONA  85345
Phone: (623) 773-7017
Fax: (623) 825-6514
alarms@peoriaaz.gov					


103-011   DEC99