ALARM USER PERMIT APPLICATION City Of Wheaton . - Frontpoint Security

ALARM USER PERMIT APPLICATIONCity of Wheaton Police Department900 West Liberty DriveWheaton, Illinois 60187Telephone: 630.260.2161CHECK ONE:[ ] Residence[ ] Business(Questions 1-3 to be completed by business establishments only)1.BUSINESS NAME:2.BUSINESS ADDRESS:3.BUSINESS TELEPHONE NUMBER:4.FULL NAME OF APPLICANT:5.APPLICANT HOME ADDRESS:6.APPLICANT HOME PHONE NUMBER: (7.ALARM COMPANY WHO INSTALLED OR MAINTAINS ALARM: FrontPoint Security)a. ADDRESS: 1595 Spring Hill Rd, Ste. 110, Vienna, VA 22182b. TELEPHONE NUMBER: ( 703) 776-91008.ALARM COMPANY WHO MONITORS ALARM (CENTRAL STATION): Rapid Responsea. ADDRESS:400 W. Division St, Syracuse, NY 13204b. TELEPHONE NUMBER: ( 800 ) 932-38229.OWNER AND PEOPLE ABLE TO RESPOND TO ALARM OR ABLE TO CONTACT OWNER IN ANEMERGENCY (KEYHOLDERS). PLEASE IDENTIFY IF BELOW NUMBERS ARE A CELLNUMBER OR A LAND LINE. IF A BUSINESS, PLEASE ADD PERSONS TITLE IF APPLICABLE.1. NAME:TELEPHONE: ()2. NAME:TELEPHONE: ()3. NAME:TELEPHONE: ()4. NAME:TELEPHONE: ()APPLICANT SIGNATUREDATE* PLEASE NOTIFY THE CITY OF WHEATON IMMEDIATELY AT 260-4861 OF ANY CHANGES(PLEASE DO NOT WRITE BELOW THIS LINE - FOR CITY USE ONLY)DATE RECEIVED:REVIEWED BY:APPROVED PERMIT NUMBER:DATE APPROVED:900 W. Liberty DriveWheaton, IL 60187Fax: (630) 260-2154

Rapid Response800-932-3822 'SPOU1PJOU 4FDVSJUZ 4QSJOH )JMM 3E 4UF 7JFOOB 7"

FrontPoint Security703-776-910

*CONFIDENTIAL INFORMATION* CITY OF ELMHURST - ALARM PERMIT RECORD *POLICE & FIRE* Revised 1/04APPLICATION FEE: (Initial Fee 25)(Renewal Fee 15)DATE OF APPLICATION:FIRST NAME:APPLICANT LAST NAME:ALARM STREET ADDRESS:CITY: ELMHURSTSTATE: ILLINOISZIP CODE: 60126PHONE NUMBER:IF THIS IS AN ALARM FOR A BUSINESS, PLEASE PROVIDE THE FOLLOWING INFORMATION:BUSINESS OWNER'S NAME:BUSINESS NAME:BUSINESS ADDRESS:BUSINESS PHONE NUMBER:ALARM INFORMATION Fire AlarmPolice AlarmALARM INSTALLED BY:self-installed by alarm userPHONE NUMBER:ALARM MONITORED BY: Rapid ResponsePHONE NUMBER: 800-932-3822ALARM SERVICED BY: FrontPoint SecurityPHONE NUMBER: 703-776-9100CHECK ALL OF THE FOLLOWING THAT APPLY TO THE TYPE OF ALARM INSTALLED:AUTO/DIALING DEVICE:AUTO/HOLD UP ALARM:AUTO BURGLAR ALARM:MAN/HOLD UP ALARM:AUDIBLE:DIRECT CONNECT:ANSWERING SERVICE:CENTRAL STATION:LOCAL PREMISES ONLY:SILENT: SPRINKLER:AUTO FIRE:MANUAL FIRE:COMBINATION:MOTION OTHER (EXPLAIN):CONTACT PERSON (MINIMUM OF TWO NAMES REQUIRED)PLEASE PROVIDE THE NAMES OF PERSONS WHO CAN BE CONTACTED AT ANY TIME, DAY OR NIGHT, WHO AREAUTHORIZED TO RESPOND TO AN ALARM SIGNAL AND WHO CAN OPEN THE SYSTEM. PLEASE PROVIDE ATLEAST TWO NAMES.NAME:PHONE NUMBER:NAME:PHONE NUMBER:NAME:PHONE NUMBER:SIGNATURE OF APPLICANTDATEMAKE YOUR CHECK PAYABLE TO:CITY OF ELMHURSTMAIL APPLICATION TO:CITY CLERK 209 N. YORK ELMHURST, IL ************************FOR OFFICE USE ONLYDATE RECEIVED:MAILED TO APPLICANT:POLICEFIREPERMIT EXPIRES:APPLICANT RECEIPT

Application Fee: 50.00Annual Renewal Fee: 25.00Date of Application:VILLAGE OF ROSELLE31 S. Prospect StreetRoselle,ILALARM PERMIT APPLICATION60172Company Name or Property Owner (if residence)Protected Premises address and Telephone NumberPremises on DescriptionCommercialResidentialOtherType of Alarmx Burglarx Hold UpFirex MedicalOtherWireless system self-installedName of Alarm Installation CompanyAddress City State PhoneRapid ResponseName of Alarm Monitoring Company400 W. Division StNY t SecurityName of Company Servicing AlarmViennaVA Phone703-776-91001595 Spring Hill Rd, Ste 110 CityAddressStateName of Person to whom all Alarm Correspondence Shall be DirectedName / Position:Address City State PhoneProvide a list of three people who can be contacted and will respond to the premises in the event of anemergency or to reset or deactivate the alarm system.1. Name AddressPhone Cell Pager e-mail2. Name AddressPhone Cell Pager e-mail3. Name AddressPhone Cell Pager e-mailAPPLICANT’S SIGNATUREDATEOFFICIAL USEDate Received:Reviewed by:Approved: Disapproved: Permit Number:Provided with a copy of Alarm Ordinance

FrontPoint Security. 1595 Spring Hill Rd, Ste. 110, Vienna, VA 22182. 703. 776-9100. Rapid Response. 400 W. Division St, Syracuse, NY 13204. 800. 932-3822 'SPOU1PJOU 4FDVSJUZ 4QSJOH )JMM 3E 4UF 7JFOOB 7" RapidResponse 800-932-3822. FrontPoint Security 703-776-910