Alarm System Registration

The following information is confidential and is used only by the Bloomfield Township Police Department to better serve the residents and businesses in a premise equipped with an alarm system. Note there is an Alarm System Permit fee of $10.00 payable online after submitting this form.

Occupant Name *

Primary Phone *

Secondary Phone

Installation Address *

City *

Zip Code *

Alarm Company Name *

Alarm Company Phone *

Alarm Company Address *

Person(s) to Contact in Case of Emergency

The following list of people may be contacted to reset the alarm, check the premises or can be notified in the event of an emergency. Please list at least one (1).

Emergency Contact 1 Name *

Contact 1 Phone *

Emergency Contact 2 Name

Contact 2 Phone

Emergency Contact 3 Name

Optional

Contact 3 Phone

Emergency Contact 4 Name

Optional

Contact 4 Phone

Emergency Contact 5 Name

Optional

Contact 5 Phone

After submitting this form, please use the button below to complete the online payment of the $10 Alarm System Permit Fee.

Pay Online