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NORTH BRUNSWICK POLICE DEPARTMENT
710 HERMANN ROAD
NORTH BRUNSWICK, NEW JERSEY 08902
ALARM APPLICATION/REGISTRATION FORM
PLEASE PRINT
| RESIDENTIAL |
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NAME OF RESIDENT |
ADDRESS |
TELEPHONE |
| COMMERCIAL |
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NAME OF FIRM |
ADDRESS |
TELEPHONE |
| AlarmService |
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ALARM COMPANY |
ADDRESS |
TELEPHONE |
| IF AUTOMATIC DIALER TO POLICE DEPT. IS USED FOR YOUR BURGLAR
ALARM, THE NUMBER TO CALL IS (732) 247-1553. |
| IF AUTOMATIC DIALER TO POLICE DEPT. IS USED FOR YOUR FIRE ALARM,
THE NUMBER TO CALL IS (732) 828-5554. |
| TYPE OF ALARM CONNECTION |
|
CHECK ONE ONLY |
|
TYPE OF ALARM |
|
CHECK ALL THAT APPLY |
| CENTRAL OFFICE |
|
( ) |
|
BURGLAR |
|
( ) |
| LOCAL (ON SITE) |
|
( ) |
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FIRE |
|
( ) |
| DIALER TO POLICE DEPT |
|
( ) |
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MEDICAL |
|
( ) |
| ALARM PANEL AT POLICE HQ |
|
( ) |
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OTHER * |
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( ) |
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* specify |
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| TYPE OF ALARM SITE |
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CHECK ONE ONLY |
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| HOME ALARM |
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( ) |
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| BUSINESS ALARM |
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( ) |
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LIST INDIVIDUALS TO BE CONTACTED IN CASE OF EMERGENCY:
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NAME
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PHONE
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| FIRST |
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| SECOND |
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| THIRD |
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IT IS HEREBY UNDERSTOOD AND AGREED THAT THE REGISTERED PARTY
SHALL RELEASE THE TOWNSHIP OF NORTH BRUNSWICK, ITS OFFICERS, AGENTS AND
EMPLOYEES FROM ANY AND ALL LIABILITY OR DAMAGES DIRECTLY OR INDIRECTLY
RELATED TO THE INSTALLATION, OPERATION OR MAINTENANCE OF ANY ALARM
EQUIPMENT LOCATED AT THE REGISTERED PARTY'S PREMISES.
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