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2. Security Alarm Registration
   This form is utilized to register a new alarm system or to update information concerning a current system already registered.
4. There is NO FEE to register your alarm or to update your alarm related information.
6. Submit
   Complete the form below and submit the request online. Alternatively, the below application can be printed and brought or mailed to Casselberry Police Department, 4195 South U.S. Highway 17/92, Attention: Alarm Program, Casselberry, Florida 32707 or sent by fax to (407) 262-7638.
8. Select the type of service.*

   1. New System
   2. Update to System and/or Information
10. Alarm Type(s): Check all that apply*

    1. Burglary Alarm
    2. Fire Alarm (Information is provided to Seminole County Fire Department)
    3. Hold-Up Alarm
    4. Panic Alarm
14. Business or Resident Name*
16. Address*
18. Suite or Apartment Number
20. City*
21. State*
22. Zip*
24. On Premise Phone Number*
25. Shopping Center or Subdivision Name*
27. Email Address
    Under Florida law, email addresses are public records.
31. Name of Alarm Company*
32. Alarm Monitoring Center Phone Number*
36. Business or Resident Mailing Address if different from alarm system location above
38. Mailing Address
40. City
41. State
42. Zip
46. Do you OWN the property on which the security system is located?*
    -- Select One --YesNo

    Press the down arrow key to access the values available for this field or start typing to filter the values
47. If No, please indicate property owner information requested below.
49. Property Owner Name
50. Phone Number
52. Address
54. City
55. State
56. Zip
60. This serves as a document of registration with the Casselberry Police Department for the alarm system(s) noted above. In the event of an alarm, please contact the following person(s) after named Business or Resident above.
62. Contact #1
64. First Name*
65. Last Name*
67. Address*
69. City*
70. State*
71. Zip*
73. A minimum of one phone number per contact is required
75. Cell Phone Number
76. Work Phone Number
77. Other Phone Number
81. Contact #2
83. First Name
84. Last Name
86. Address
88. City
89. State
90. Zip
92. Cell Phone Number
93. Work Phone Number
94. Other Phone Number
98. Contact #3
100. First Name
101. Last Name
103. Address
105. City
106. State
107. Zip
109. Cell Phone Number
110. Work Phone Number
111. Other Phone Number
115. Additional Information You Wish to Provide
119. Per Casselberry Code Section 34.38 (C)(1)(2) Burglar Alarm Service Fees:
121. (1) No fee shall be assessed for any of the first three false alarms at the same premises during any consecutive 6-month period. The fourth false alarm and all subsequent false burglar alarms thereafter shall be assessed a service fee of $100 each.
123. (2) The fee shall be billed to the owner, lessee, or manager of the premises, whichever shall be in residence on the premises. An alarm will be considered valid ONLY if it is the result of a reported crime.
127. 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.
129. Electronic Signature*

     1. I agree.
131. Signature*
132. Date*
     Date
134. Email Notice
     Under Florida law, e-mail addresses are public records. If you do not want your e-mail address released in response to a public-records request, do not send electronic mail to this entity. Instead, contact this office by phone or in writing.
Leave This Blank:


136. 1. Receive an email copy of this form.
137. Email address

     This field is not part of the form submission.

138. Submit Submit and Print

* indicates a required field