Required Fields are marked with a *
 
PART I: ALARM USER INFORMATION
 
Type of Alarm System *
   (check all that apply)
For Alarm type 'Other', please specify:
Alarm Address  
Alarm Address is *
Street Name of Alarm Location *
Street Number *
Apartment Number
Zip Code *
Phone at Alarm Location * (Including Area Code)
Daytime Phone of Alarm User, if different (Including Area Code)
Last Name or Business Name *
First Name   (for Residential Alarms Only)
Person Responsible for Security
    (First and Last Name for Business Alarms Only)
 
Mailing Address
Is the mailing address same as the alarm address?
Address
City
State and Zip  
 
PART II: MONITORING AND INSTALLATION INFORMATION
Address of Alarm Installer
Name of Alarm Installer
Address
City
State and Zip  
Phone of Alarm Installer (Including Area Code)
 
Is Alarm Monitored? (choose Yes or No) *
If you answered "Yes" to the above question (Is Alarm Monitored?), please provide the following information otherwise go to PART III.
 
Address of Alarm Monitor
Name of Monitoring Company
Address
City
State and Zip  
Phone (Including Area Code)
24-Hour Phone (if Different) (Including Area Code)
 
PART III: EMERGENCY CONTACT INFORMATION
Please designate a "Keyholder" or other responsible party who can assist emergency personnel if the Alarm Owner is not available
 
Address of Key Holder
Name of Keyholder
Address
City
State and Zip  
Phone (Including Area Code)
 
PART IV: VERIFICATION AND REGISTERATION
 
 
Your Name *
Your Phone * (Including Area Code)
Your Email
 
 
Questions? Please call (203)977-4460 between 9am to 4pm Monday through Friday.
City of Stamford Alarm Administrator
888 Washington Blvd. Stamford, CT 06901






1. Provide information

2. Validate provided information

3. Verify provided information

4. Register Alarm

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