Alarm Permit Application Form - City Of Terrell, Texas
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1
2City Of Terrell
ALARM PERMIT APPLICATION
Date of Application:___________________
New Request / Renewal #________
(Circle one)
Alarm Type
Burglar -
Fire -
Medical -
(Circle one):
Alarm Site
Residential -
Commercial -
(Circle one):
1. Contact Name: _____________________________ Business Name: ________________________________
Service Address:____________________________________________________________Terrell__TX__75160
Street Address
Apt#
Mailing
Address:___________________________________________________________________________________
Street Address
Apt#
City
State
Zip Code
Telephone #1:__________________________________ Telephone #2:_________________________________
2. Emergency Contact Information (
:
for identification purposes, please provide a full name and DOB or Drivers license number).
A) Full Name:__________________________________ Date of Birth____/____/____DL#_________________
Address:____________________________________________________________________________________
Telephone #1:__________________________________ Telephone #2:__________________________________
B) Full Name:___________________________________ Date of Birth____/____/____DL#_________________
Address:____________________________________________________________________________________
Telephone #1:__________________________________ Telephone #2:__________________________________
3. Alarm Monitoring Company: _______________________________________________________________
Address: ____________________________________________________________________________________
Telephone:______________________________________ License NO:_________________________________
I accept responsibility for payment and all fees/charges that may result from the operation of alarm system.
Applicant’s Signature: _____________________________________________Date: _____________________
(To be completed by Office Personnel)
Expiration Date: _______________________________
Permit No:_______________________________
Issued by:_______________
Date:_______________
General Receipt No:_______________________
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