Alarm Registration

2. 
3. ALARM REGISTRATION FORM
4. 
7. Account #
9. Complete all application items. Complete a separate application for each address to be permitted. Registration is MANDATORY but at no charge.
13. Alarm Location
15. Occupant Name or Business Name*
16. Phone #*
18. Address1*
20. Address2
22. City*
23. State*
24. Zip*
25. Email Address*
29. Mailing Address
30. Same as above

    1. Same as above
32. Name*
34. Address1*
36. Address2
38. City*
39. State*
40. Zip*
42. Phone #1*
43. Phone #2
44. Phone #3
45. Phone #4
49. Contact Names
51. Contact 1*
52. Phone #1*
53. Phone #2
55. Contact 2
56. Phone #1
57. Phone #2
59. Contact 3
60. Phone #1
61. Phone #2
65. Additional Information
67. Date Installed/Activated
    Date Installed/Activated
68. Audible

    1. Audible
70. Special Conditions/ Hazards
74. Alarm Companies
75. Not Monitored

    1. Not Monitored
77. Monitored By*
78. Phone #*
80. Installed by
81. Phone #
85. I understand that, in accordance with City Ordinance Title 7 Sec. 9-13 Alarm-Code, applicant is financially responsible for all charges and penalties specific in this section. Annual Alarm Site registration is MANDATORY on or before January 15 of each year!
87. Spacer
88. Digital Signature*

    By typing your name, you agree with, and will comply with the above statement.

89. Date*
    Date
91. NOTE: If information provided in application changes, you MUST notify City of Pueblo within fifteen (15) working days at:
    PUEBLO POLICE DEPARTMENT ALARM ADMINISTRATOR
    200 S. MAIN STREET
    PUEBLO, CO 81003
Leave This Blank:


92. 1. Receive an email copy of this form.
93. Email address

    This field is not part of the form submission.

94. Submit

* indicates a required field