Clayton Police Department

6000 Heritage Trail, Clayton, CA 94517

925-673-7350

ALARM REGISTRATION FORM

Please complete the information below, print

and return with your check to the address above.

Subscriber’s Name: _________________________________________________________________

Subscriber’s Address: _______________________________________________________________

Subscriber’s Telephone: _____________________________________________________________

Subscriber’s Pager/Voice Mail: _______________________________________________________

Emergency Contacts (Who Can Turn Off Alarm):

Name: Telephone Number:

______________________________ _______________________

______________________________ _______________________

______________________________ _______________________

Alarm Company: __________________________________________________________________

Telephone Number: _______________________________________________________________

Additional Information: _____________________________________________________________

Subscriber Signature: _______________________________________________________________