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2. Instructions
   • Please add area code to phone numbers in this format: 999-999-9999.
   • If you have any problems processing the request, please contact the False Alarm Reduction Unit at 336-773-7886.
4. Type of Application

   1. New
   2. Information Update
8. Alarm User / Business Information (Alarm Location)
10. First Name (or Business Name)*
11. Middle Initial
12. Last Name*
14. Street Address*
15. Apartment / Suite / Room Number
17. City & State*
18. ZIP Code*
20. Home Phone*
21. Work Phone*
22. Cell Phone*
23. Email Address
27. Mailing Address (Skip if Same as Street Address above)
29. City & State
30. ZIP Code
34. Contact Persons
    List two people who can respond to the alarm site within 30 minutes. (Examples: a relative, a neighbor, etc.)
36. Contact 1 Last Name*
37. Contact 1 First Name & Middle Initial *
39. Contact 1 Home Phone Number*
40. Contact 1 Cell Phone Number
42. Contact 2 Last Name*
43. Contact 2 First Name & Middle Initial*
45. Contact 2 Home Phone Number*
46. Contact 2 Cell Phone Number
50. Alarm Installation Company Name
51. Alarm Monitoring Company Name
52. Date of Installation
    Date of Installation
Leave This Blank:


54. 1. Receive an email copy of this form.
55. Email address

    This field is not part of the form submission.

56. Submit

* indicates a required field