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2. COLCHESTER POLICE ALARM REGISTRATION - Commercial
4. Business Name*
6. Business Address*
7. Business Phone Number*
9. Person Responsible for Alarm*
11. Contact Number*
12. Email*
14. IF MAILING ADDRESS IS NOT THE ALARMED ADDRESS, PLEASE COMPLETE THE FOLLOWING:
16. Street Name
18. City / Town
19. State
20. Zip Code
22. This submission is a:*

    1. New registration
    2. Existing registration renewal
24. CONTACT INFORMATION:
26. PLEASE LIST THREE INDIVIDUALS WHO HAVE KEYS / ACCESS TO THE PROPERTY IN CASE OF AN EMERGENCY:
28. Contact # 1*
29. Primary Phone Number*
31. Secondary Phone Number
33. Has key to business?*

    1. Yes

    1. No
37. Contact # 2
38. Primary Phone Number
40. Secondary Phone Number
42. Has key to business?

    1. Yes

    1. No
46. Contact # 3
47. Primary Phone Number
49. Secondary Phone Number
51. Has key to business?

    1. Yes

    1. No
53. ALARM MONITORING COMPANY INFORMATION:
55. Please Select One*
    -- Select One --ADTCentra-larmDieboldFederated Fire / SecurityHome SecurityInterfaceLive WatchMetro DialMonitronicsNortheastern SecurityProperty ProtectionProtection 1Rapid ResponseRound Hill SecuritySentinelStanley SecuritySummitTyco IntegratedXfinity / ComcastOther
56. 24 Hour Phone Number*
58. If Other please list here:
59. Phone Number
61. ACKNOWLEDGEMENT:
63. 
65. 
67. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
69. Electronic Signature*
71. THANK YOU
Leave This Blank:


73. 1. Receive an email copy of this form.
74. Email address

    This field is not part of the form submission.

75. Submit

* indicates a required field