Application to Operate an Alarm

Annual Renewal Fee:	$25 until April 5 Each Year
Late Fee & Renewal:	$50 after April 5 Each Year

Annual Fee may be paid by check or online by credit card.

To pay by check:
- Fill out form below and submit
- MAIL check and copy of confirmation email to: Town of North Castle – Alarms, North Castle Police Department, 15 Bedford Road - Armonk, NY 10504.
To pay online by credit card:
- Fill out form below and submit
- Once submitted, you will receive the link to the online payment portal.
- Processing provider Value Payment Systems charges additional fees. If you are paying by credit or debit card, the additional fee is 2.45% of the transaction amount with a $1.75 minimum. If you are paying with an E-Check, the fee is $1.75.

Please supply any additional information helpful for full consideration of an alarm permit. Misstatement of fact shall be cause for refusal of permit or for immediate revocation of permit if issued.

Today's Date *

Month

Day

Year

This is the date of your application

Name *

Address *

Mailing Address

If different

Primary Telephone *

Please use a phone to contact first in case of emergency

Alternate Telephone

If applicable

Primary Email *

Please use an address that you check often

First Permit Holder Name *

First Permit Holder Primary Telephone *

Please use phone number that will be answered in case of emergency

First Permit Holder AlternateTelephone

First Permit Holder Primary Email *

Second Permit Holder Name

Second Permit Holder Primary Telephone

Please use phone number that will be answered in case of emergency

Second Permit Holder AlternateTelephone

Second Permit Holder Primary email

Emergency Contact 1 Name *

must list at least 1 emergency contact name & number

Emergency Contact 1 Telephone *

Emergency Contact 1 Keyholder *

Choose YES or NO

Emergency Contact 2 Name

Emergency Contact 2 Telephone

Emergency Contact 2 Keyholder

Choose YES or NO

Emergency Contact 3 Name

Emergency Contact 3 Telephone

Emergency Contact 3 Keyholder

Choose YES or NO

This is an application for: *

Burglar

Fire/CO Detector

Panic Alarm System

This system: *

is connected to Private Monitoring

has an Audible Bell

is a Gated Location

Gate Code:

If Manual Entry, please provide instructions to Open the Gate.

Alarm Provider

Name of Company

Alarm Provider Address

Alarm Provider Telephone

Private Alarm Monitoring

Name of Company

Private Alarm Monitoring Address

Private Alarm Monitoring Telephone

Applicant’s Electronic Signature *

By typing your name you are electronically signing this application.

Payment Method *

Mail Check

Pay by Card

Mail Check or Pay by Card

Leave this field blank

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Annual Fee may be paid by check or online by credit card.