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Alarm Registration Form

2. Alarm Registration Form
   York County Ordinance requires all alarm systems be registered with the county. York County does not issue permit numbers, nor is there a fee for alarm systems being registered.

   York County Ordinance requires all alarm systems be registered with the county. York County does not issue permit numbers, nor is there a fee for alarm systems being registered.

4. Date:*
   Date:

6. Alarm Location Address:*

7. Apartment / Suite #:

9. Mailing Address (if different):

11. City*

12. State

13. Zip Code

15. Business / Resident Name:*

17. Home Phone:

18. Work Phone:

19. Alternate Number:

21. Name of Power Company:*

23. Alarm Company Name:*

24. Alarm Company Phone:*

26. Type of Alarm:*

    1. Fire
    2. Medical
    3. Burglar
    4. Other

28. Other Alarm Type

30. Name of Subdivison/Office Complex:

34. Emergency Contact #1 Name:

36. Emergency Contact #1 Home Phone:

37. Emergency Contact #1 Cell Phone:

39. Emergency Contact #1 Work Phone:

40. Emergency Contact #1 Other Phone:

44. Emergency Contact #2 Name:

46. Emergency Contact #2 Home Phone:

47. Emergency Contact #2 Cell Phone:

49. Emergency Contact #2 Work Phone:

50. Emergency Contact #2 Other Phone:

54. Emergency Contact #3 Name:

56. Emergency Contact #3 Home Phone:

57. Emergency Contact #3 Cell Phone:

59. Emergency Contact #3 Work Phone:

60. Emergency Contact #3 Other Phone:

64. Brief Directions from Highway:

66. Other Important Information:

Leave This Blank:


68. 1. Receive an email copy of this form.
69. Email address

    This field is not part of the form submission.

70. Submit

* indicates a required field