BERNARDS TOWNSHIP POLICE DEPARTMENT
ONE COLLYER LANE, BASKING RIDGE, NEW JERSEY 07920
PHONE: (908) 766-1122 FAX: (908) 766-0575

ALARM REGISTRATION FORM


INSTRUCTIONS:
Please complete this form, click 'NEXT' to continue.


DATE OF APPLICATION: 10/01/2014       DATE OF HOOKUP:

RESIDENT/BUSINESS NAME:

Type a few characters of the street name then press the ENTER key to bring up street listing.  Select a street from the list for the ALARM LOCATION ADDRESS below.

ALARM LOCATION ADDRESS:
     STREET NUMBER:    (SELECT STREET NAME)
       NJ   07920
     PHONE:      CELL PHONE:
     EMAIL ADDRESS:


NAME OF PERSON RESPONSIBLE FOR PREMISES:
     ADDRESS:
     CITY:  STATE:  ZIP:
     PHONE:      CELL PHONE:


NAME OF COMPANY INSTALLING & MAINTAINING ALARM:
     ADDRESS:
     CITY:  STATE:  ZIP:
     PHONE:  CELL PHONE:
     EMAIL ADDRESS:


ALARM TYPE: (You must check at least one)

NOTE: EVERY WARNING DEVICE MUST BE EQUIPPED WITH A TIME RELAY OR BATTERY TO LIMIT THE SOUNDING OF AN ALARM TO 30 MINUTES OR LESS

IN CASE OF EMERGENCY, LIST IN PRIORITY ORDER THE KEYHOLDERS:
1) NAME OF PERSON RESPONSIBLE FOR PREMISES:
      ADDRESS:
      CITY:
      STATE:  ZIP:
      PHONE:
      EMAIL ADDRESS:

2) NAME OF PERSON RESPONSIBLE FOR PREMISES:
      ADDRESS:
      CITY:
      STATE:  ZIP:
      PHONE:
      EMAIL ADDRESS:

3) NAME OF PERSON RESPONSIBLE FOR PREMISES:
      ADDRESS:
      CITY:
      STATE:  ZIP:
      PHONE:
      EMAIL ADDRESS: