First Time Home Alarm 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:

Spouse Name: Spouse Date of Birth:

ALARM INFO: (required)
Clear Code:
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

Does your house have a video surveillance system? 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 INCLUDED IN YOUR CONFIRMATION EMAIL AND SUBMIT THE NECESSARY FEES TO COMPLETE YOUR REGISTRATION. FORMS SUBMITTED WITHOUT PAYMENT WILL NOT BE PROCESSED.