Alarm Registration Form

Emergencies Only: 9-1-1
Emergency: (413) 527-1124
Business: (413) 527-1120
Fax: (413) 527-8776
ORI: MA0081600

8 East Street
PO Box 239
Southampton, MA 01073

Alarm registration area

The Southampton Police asks for your cooperation if your business or residence has an alarm system. If you have an alarm please fill out the form below to help the police department serve you better. Any information provided will be considered strictly confidential.


Name:
Address


Phone:	()-
Type of premises:
Name of alarm monitoring company:
Monitoring company phone:	()-
Is the alarm audible:	Yes No
Does the alarm reset automatically, if so how long until the alarm resets:	Yes No Resets in minutes
Does the alarm report to a central monitoring agency?	Yes No
Is your house number easily visible from the road?	Yes No If your house number is not displayed please display them for quicker response time.
Have you left keys with anyone?	Yes No
Does anyone have access to the building when you are absent?	Yes No
If so, who?
Name:
Address:
Phone:	() -
Relation:

In case of an emergency do you wish to be contacted by collect call?	Yes No Phone: ()-
Please list people to be notified in your absence:
Contact 1 Name:
Address:
City:
State:
Phone:	()-
Contact 2 Name:
Address:
City:
State:
Phone:	()-
Contact 3 Name:
Address:
City:
State:
Phone:	()-
Please add any other comments you feel are important:

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