PUTNAM COUNTY 911

                                                                PUTNAM COUNTY COURTHOUSE #20

                                                               1600 W CO RD 225 S

                                                                GREENCASTLE IN 46135

                                                                PHONE:  (765) 653-5115

                                                                                          795-4791

                                                                FAX:    (765) 653-5117

                                                                dcostin@ccrtc.com

ALARM REGISTRATION FORM

DATE:_________________________

Person responsible for Alarm Site:  ____________________________

Address:  ____________________________

          ____________________________

Address/Location of the Alarm Site:

___________________________________

___________________________________                                               

Business name of the site: ____________________________

Please include any special driving directions to the alarm site, landmarks, and normal business hours, etc.:

The daytime telephone number of the site:  ______________________

On what date was the alarm installed: ______________________

What is the purpose of the alarm:  _____________________________

How is the alarm activated:  __________________________________

Other than contacting an alarm company or summoning a public safety agency, what further action does the alarm system perform (e.g. does it call a keyholder respond—if so, who, does it trigger sprinkler systems, release halon, etc. and if so where are the controls for these?):

___________________________________________________________________________________

 

Where exactly is the main control unit for the alarm system located within the site:

What is the name of the Company or Person who is primarily responsible for maintaining your alarm system:

What is the emergency 24 hour number for this Company/person:

Please provide the names of at least two persons responsible for being called after normal business hours to respond to an alarm activation and the phone numbers that they can be reached after normal hours.  Please list the persons in the order that you wish them to be called:

Signed:  ____________________________  Dated:  ___________________________

Copies sent to:  _________________________________________________________