Emergency Contact Form Fire Alarm Systems Sentry Emergency Contact List Form Date * Account Number * E-Mail Address * Name * Street Address * Premise Phone City State Zip Code List contacts below in the order the contacts are to be called PRIOR to contacting the police. Include yourself if you are to be contacted. Only provide telephone numbers to be useda Name * Phone Number * Phone Type * SelectPremCellWork Name Phone Number Phone Type SelectPremCellWork Name Phone Number Phone Type SelectPremCellWork List contacts below in the order the contacts are to be called AFTER contacting the police. Include yourself if you are to be contacted. Only provide telephone numbers to be used. Name * Phone Number * Phone Type * SelectPremCellWork Name * Phone Number * Phone Type * SelectPremCellWork Name * Phone Number * Phone Type * SelectPremCellWork MUST PROVIDE: Passcode/Cancel code *The passcode is a word and/or number that is used for identification purposes to cancel a false alarm. The Central Station will dispatch on an alarm, even if told it is a false alarm, if the correct passcode is not given. Passcode/Cancel code * Central Station Trouble Protocol Checklist Date * Account Number * E-Mail Address * Please check how you’d prefer to be notified on the following conditions. Trouble Condition * General Burglar Alarm Trouble Notification Type (check) * SelectPremise OnlyContact ListEmail Trouble Condition * General Fire Alarm Trouble Notification Type (check) * SelectPremise OnlyContact ListEmail Trouble Condition * Temp Sensor Alarm Notification Type (check) * SelectPremise OnlyContact ListEmail Trouble Condition * Water Sensor Alarm Notification Type (check) * SelectPremise OnlyContact ListEmail Trouble Condition * Power Failure Notification Type (check) * SelectPremise OnlyContact ListEmail Trouble Condition * Telephone/Communication Trouble Notification Type (check) * SelectPremise OnlyContact ListEmail Trouble Condition * Low Battery Notification Type (check) * SelectPremise OnlyContact ListEmail Message * By checking this box * I acknowledge and agree to the information provided above and understand that this checkbox represents my electronic consent. Submit If you are human, leave this field blank.
