| Type of Alarm Hookup: | Type of Alarm: | ||
| Central Office | ( ) | Burglar | ( ) |
| Local (on site) | ( ) | Fire | ( ) |
| Dialer | ( ) | Other* | ( ) |
| *Specify___________________ | |||
____________________________________________________________________________
Residence or Business Name
Telephone No.
____________________________________________________________________________
Address
If Residence Alarm, Work No.
____________________________________________________________________________
Alarm Company
Address
Telephone No.
____________________________________________________________________________
Type of Equipment
Manufacturer
Model
List individuals to be contacted in case of emergency (Should have access to property):
| First Contact | Second Contact | Third Contact | |
| Name | |||
| Phone Number |
Date Alarm Installed: ________________________
_____________________________________________
Signature of Owner
Date: ____________
_____________________________________________
Corporation Represented
It is hereby understood and agreed that the Permittee shall release the Township of East 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 Permittee's premises.
Do not write below this line.
_____________________________________________________________________________
Approved
( )
Disapproved (
)
Comments: ___________________________________________________________________