814-765-1533

Alarm Registration

"*" indicates required fields

Residence*

Commercial

Residential

Name*

Date*

Address*

Phone

Cell Phone*

Email*

Name and Title of Key Holder 1*

Key Holder's Address*

Vehicle Description (If known)

Home Phone

Cell Phone*

Name and Title Key Holder 2

Key Holder's Address

Vehicle Description (If Known)

Home Phone

Cell Phone

Company Name*

Alarm Type

Check All That Apply

Burglar Alarm

Fire Alarm

Panic Alarm

Medical

Exterior Audible Siren*

Yes

"*" indicates required fields

1094 Chestnut Avenue
DuBois, PA 15801
P: 814-765-1533
P: STATION 814-371-4220
F: 814-371-2573