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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.
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