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2. Town of Lexington Alarm Permit Application
4. Alarm User Information (Alarm Location)
6. Business

   1. Yes
   2. No
8. Last Name*
9. First Name*
11. Middle Initial
12. Business Name
14. Address*
15. Appt/Suite #
17. City*
18. State*
20. Zip *
21. Email Address
23. Home Phone*
24. Work Phone
26. Cell Phone
28. Set Password (6 - 10 Characters)
30. Password*
31. Confirm Password*
33. List two (2) People to contact in the event of an alarm (who can respond within 30 minutes)
35. Contact 1
37. Last Name*
38. First Name*
40. Home Phone*
41. Work Phone
43. Cell Phone
45. Contact 2
47. Last Name*
48. First Name*
50. Home Phone*
51. Work Phone
53. Cell Phone
55. Alarm Company Information
57. Company Name*
58. Phone Number*
60. Burglar Alarm License Number*
61. Email*
63. Monitoring Company Information (if different from Alarm Company)
65. Company Name
66. Phone Number
68. Special Conditions at location (i.e., watch dog, disabled persons, hazardous materials, etc.)
Leave This Blank:


70. 1. Receive an email copy of this form.
71. Email address

    This field is not part of the form submission.

72. Submit Submit and Print

* indicates a required field