Once completed, this form must be printed, signed and then submitted to the appropriate City of Lewisville department along with any required fees.
CITY OF LEWISVILLE - ALARM SECTION
P.O. BOX 299002 Lewisville, TX 75029-9002
ALARM REGISTRATION / RENEWAL
Phone: 972-219-3430

#:
Please fill out the information, print, sign, date and return to the Alarm Section. If annual registration renewal, return form with payment. Complete only those sections that apply.

$50.00
   registration/renewal fee enclosed (Check or money order payabe to the City of Lewisville.)

ALARM TYPE:
EXPIRES:

LOCATIONRESPONSIBLE PARTY
Name (Last, First or Business Name)Name (Last, First or Business Name)
Str # Street Name Apt/SuiteStr # Street Name Apt/Suite
City, State, ZipCity, State, Zip
Email Address Email Address
Phone 1                                              Phone 2Phone 1                                              Phone 2
Phone 3                                             Phone 4Phone 3                                             Phone 4

CONTACT PERSON 1CONTACT PERSON 2
Name (Last, First)Name (Last, First)
Str # Street Name Apt/SuiteStr # Street Name Apt/Suite
City, State, ZipCity, State, Zip
Email Address Email Address
Phone 1                                              Phone 2Phone 1                                              Phone 2
Phone 3                                             Phone 4Phone 3                                             Phone 4
Special Conditions:

MONITORED BYSERVICED BY
Company Name (Last, First)Company Name (Last, First)
Str # Street Name Apt/SuiteStr # Street Name Apt/Suite
City, State, ZipCity, State, Zip
Phone 1                                              Phone 2Phone 1                                              Phone 2


Signature of Alarm Location OwnerDate