Iron County Sheriff's Office

Applicant Information

Is this application for a business?

YesNo

First Name

Last Name

Phone

Format: 123-456-7890

Date of Birth

Alarm Location Address

Address Line 1

Address Line 2

City

State

ZIP Code

Is the mailing address the same as the alarm location address?

YesNo

Alarm System Information

Type of Alarm System

Alarm sensor types*

MotionWindow / Door ContactSecurity and Fire Alarm

Alarm Company Information

Alarm Company Name

Alarm Company Phone

Address Line 1

Address Line 2

City

State

ZIP Code

Is the alarm monitored by a different company than the installer?

YesNo

Responsible Contact #1

First Name

Last Name

Phone

Format: 123-456-7890

Date of Birth

Address Line 1

Address Line 2

City

State

ZIP Code

Responsible Contact #2

First Name

Last Name

Phone

Format: 123-456-7890

Date of Birth

Address Line 1

Address Line 2

City

State

ZIP Code

Responsible Contact #3 — Optional

First Name

Last Name

Phone

Format: 123-456-7890

Date of Birth

Address Line 1

Address Line 2

City

State

ZIP Code

Consent

I certify that the contacts listed above are responsible persons who can respond to the alarm, understand the alarm system, and can gain entry and secure the premises when necessary. I certify that this application is true and correct and agree to comply with applicable ordinances and state laws.

I agree to the terms above.*