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2. Type of Permit*

   1. Residential

   1. Business
4. Alarm Address*
6. Alarm Company Name*
7. Alarm Company 24 Hour Phone Number*
9. System Information*

   Device Description and Operational Specifications: (Check all that apply)

   1. Audible
   2. Central Station Alarm

   1. Burglar Alarm
   2. Fire Alarm
11. Does the Alarm System automatically reset?*

    1. Yes
    2. No
13. Does the Fire equipment comply with UL, NFPA or equivalent standards?

    1. Yes
    2. No
15. Emergency contact name and phone number for when the Alarm goes off:*
17. Other information Responders should be aware of (List cleaning service schedule, animals, special needs, .....) ?
19. Billing/Contact Information
21. First Name*
22. Last Name*
23. Phone Number*
24. Email
26. Address*
28. City*
29. State*
30. Zip Code*
32. All installation must comply with the National Electric Code and the Electrical Code of the Village of Clarendon Hills.
34. Fee Information
    $100.00 one time Registration Fee
36. Other Fees
    False Alarm Fees: First time no charge. Second time and subsequent: Burglar/Intrusion and local $25.00; Fire and Medical Emergency $250.00.
38. Terms*

    I accept responsibility for payment of all fees and fines that may result from the operation of the alarm system servicing the above premises until such time I notify the Police Department of removal of the system and/or relation. I am also responsible for notification to the Police Department of any Alarm company changes within 10 days of change.

    1. I agree and accept the terms listed.
40. Instructions
    Print and return this application with a check in the amount of $100.00 Payable to the Village of Clarendon Hills to the Clarendon Hills Police Department located at 448 Park Ave or you can hit Submit at the bottom of this form and pay using E-Pay (note there is a $3.00 service charge for paying via credit card). Information completed will be submitted electronically to the Police Department.
44. Internal Use
Leave This Blank:


47. 1. Receive an email copy of this form.
48. Email address

    This field is not part of the form submission.

49. Submit Submit and Print

* indicates a required field