First Time Home Alarm Registration EASTON POLICE DEPARTMENT ALARM ORDINANCE REGISTRATION Please complete this form if you are registering your home alarm for the first time as a "New Registration" Your Full Name (required): Your Date of Birth (required): Your Address (required): Your Email (required): Home Telephone (required): Cell Phone (required): Work Phone: Emergency Telephone: Keyholder(s): Keyholders must have keys AND the alarm code for your home Name: Phone: Address: Name: Phone: Address: ALARM INFO: (required) Safe word: Monitored by Central Station? YESNO Alarm Company Name: Phone No.: FEATURES: please select YES or NO Intrusion Detection: ---YESNO Fire Detection: ---YESNO Medical Alert: ---YESNO CO Detection: ---YESNO Panic Alarm: ---YESNO Low Battery: ---YESNO INTRUSION DETECTORS: please select YES or NO Is the alarm audible outside of your home> ---YESNO Does your alarm have an automatic reset? ---YESNO Does your alarm only send a silent signal to the alarm co? ---YESNO If your alarm is audible, how long until it resets itself? mins. (20 minute maximum duration, please) Do you have any dogs? ---YESNO If YES, how many? Friendly? ---YESNO Use Caution? ---YESNO REMARKS: Please type the following into the box below for verification before hitting send: By submitting this form you hereby register as an alarm user in the Town of Easton, and agree to abide by the Town Ordinance regulations. UPON SUBMISSION OF THIS FORM YOU MUST CONTINUE TO THE SECURE PAYMENT PAGE AND SUBMIT THE NECESSARY FEES TO COMPLETE YOUR REGISTRATION. FORMS SUBMITTED WITHOUT PAYMENT WILL NOT BE PROCESSED.