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Occupancy / Alarm Information (Print Only)
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Alarm Type
Burglar
Fire
Hold Up
Property Owner Name
Occupancy Name
(If a business)
Property Owner Address
Occupancy Address
(If a business)
Property Owner Phone
Occupancy Phone
If a business, what are the normal hours of operation?
Are there Firearms on premises?
Yes
No
List Types
Is there a safe on premises?
Yes
No
Location
Number of dog(s) on premises
Name of Dogs
In Case of Emergency - Contact Information
Please list in order to call
Contact 1 Name
Phone Number
Address
Contact 2 Name
Phone Number
Address
Contact 3 Name
Phone Number
Address
If Alarm is Activated - Contact Information
Fill in only if different than above contacts
Contact 1 Name
Phone Number
Address
Contact 2 Name
Phone Number
Address
NOTICE
Riverside Police Department will make every reasonable attempt to notify the above of an alarm activation, however, the Village is not required to notify anyone and failure to do so does not provide the alarm user any recourse. Further, the owner/occupant is responsible to maintain the accuracy of this information at all times. Complete form in its entirety. IF you have a security system, attach the annual $60.00 fee (pay: VILLAGE OF RIVERSIDE)
Electronic Signature Agreement
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
I agree.
Electronic Signature
Date/Time
Date/Time
Date/Time
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