Forms • City of Madison • CivicEngage

ALARM PERMIT APPLICATION

Date*

ALARM LOCATION

Resident or Business name*

Type*

Address*

Apt / Suite

City*

State*

Zip*

Phone*

RESPONSIBLE PERSON

Responsible Person*

Drivers License No.*

DL State*

Address*

City*

State*

Zip*

Phone*

Cell*

Email Address*

Purpose

	Duress / Robbery
	Medical Response
	Police Response

	Fire Response
	Other

Purpose Other

ALARM INSTALLATION COMPANY

If this is a new alarm you must complete this section. Skip this section if the alarm is pre-esisting and you do not know who installed the alarm.

Installed by*

Installed on*

Address*

City*

State*

Zip*

Phone (24 Hour)*

State Permit No.*

Madison License No.*

ALARM MONITORING COMPANY

Alarm Rings To*

Company Name*

Address*

City*

State*

Zip*

Phone (24 Hour)*

Multi-tenant

Yes

No

Number of tenants

	2
	3
	4
	5

	6
	7
	8
	9 or more

EMERGENCY CONTACTS

If an emergency occurs, list in order of contact who you want notified. Ti will be the responsibility of the home or business owner to notify the Madison Police Department of any changes to this list.

Contact One

Name*

Address*

State*

Zip*

Phone*

Cell*

Contact Two

Name*

Address*

State*

Zip*

Phone*

Cell*

Contact Three

Name*

Address*

State*

Zip*

Phone*

Cell*

SPECIAL CIRCUMSTANCE

Please describe any special circumstances(s) that officers should be aware of when responding to your alarm. For instance, vicious, dangerous or exotic animals, mentally, physically or emotionally impaired individuals, or locked closets or rooms.

List Circumstance(s)

By submiting this application the registrant certifies that he or she has read the Alarm Ordinance and rules and regulations regarding the use and operation of central alarm systems within the City of Madison and that he or she agrees to be bound by the terms and conditions stated therein and any amendments hereinafter made thereto.

Created by the Law Enforcement Technology Coordinator

* indicates required fields.

Live Edit

Contact Us

Helpful Links

Site Links