Alarm Permit Application

Please fill out this form in its entirety and submit to the City of Gillette Police Department

** CHANGES MAY TAKE UP TO 10 DAYS BEFORE THEY SHOW UP IN THE SYSTEM **

Alarm Owner Name: Residential Owner or Business Name

What year are you registering for?

Accounts must be Registered every year, you can Register for the following year starting November 15th of the current year.

This is a required question

Current Year

Following Year

Physical Address: What address is the Alarm at

Billing Address

City

State

Zip Code

Primary Name (First and Last) Contact Information

Primary Name Phone Number * ### - ### - ####

Secondary Name (First and Last) Contact Information

Secondary Name Phone Number ### - ### - ####

Third Name (First and Last) Contact Information

Third Name Phone Number ### - ### - ####

Alarm Company Name

Alarm Company Billing Address

Alarm Company Phone Number ### - ### - ####

Gillette City Ordinance 14-13 *

By checking this box, you understand the terms and conditions of this application and Gillette City Ordinance 14-13

Sign Here

First Name

Last Name

Choose how to sign

Draw Type

By signing in this box, you are digitally signing this form

Date