Alarm Information Form

Alarm Company Details

Alarm Company(Required)

Alarm Company Representative Email(Required)

Details for Protected Property

Name on Alarm Account(Required)

Alarm System Details

Communicator Make & Model No.

Primary Communication(Required)

Secondary Communication(Required)

If 'Other' was selected above, please provide details.

Line Security Details

Line security requires a two-way signal path. The alarm monitoring facility must be able to poll the premises alarm system and receive a response that the line is intact. UL Line security standards call for the line to be tested and verified at intervals of every 200-seconds or 360- seconds, depending on if there is single transmission or dual transmissions.

What are the polling / testing intervals?(Required)

Please confirm the “check-in” time between the premises alarm system and the Central Station. Common settings are 200-seconds, 360-seconds, 1-hour, 24-hours, once per week and once per month. If you are unsure, please review the Detailed Alarm Activity Report to check the times between 'TIMER TEST.'

Number of Stationary Panic Buttons

Number of Remote Panic Buttons

How many vaults / safes at the premises are equipped with alarm equipment?

Additional Alarm Information (if necessary)

Multiple alarm zones, glassbreak sensors, audio sensors, remote CCTV monitoring services

Please upload the U.L. Certificate (if applicable) or any other relevant documentation

Drop files here or

Max. file size: 32 MB.

Disclaimer

As Premier Insurance Services, LLC ("Premier") do not possess access to clients' alarm contracts, activity reports and communicator programming settings, Premier specifically rely upon the information provided on this form to be true and accurate. Premier can not be responsible for inaccurate or incomplete information submitted by the reporting party. By submitting this form, you agree that the information you are providing is true and accurate.

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