Attention If you wish to file the application through the mail, please click HERE and mail the completed form to: Orem Department of Public Safety, Attn: C.S.S., 95 E. Center Street, Orem, Utah 84057, or fax it to (801) 229-7242
Fire Alarm Application
Business Name or Resident Last Name First Name M.I. Date of Birth
Address of Alarm Location: (Include coordinates) Unit # Zip Code
Mailing Address (If different from alarm location)
Residential Phone # Business Phone #
If a business – name of owner (Individual responsible for payment of alarm fees)
Alarm installer / Service Representative (Company) Address Phone
Monitoring Company Address Phone
Responsible Alarm Contacts (Three required)
Full Name Address DOB Phone#'s
Full Name Address DOB Phone#'s
Full Name Address DOB Phone#'s
Please Read Carefully before Submitting the Application
List above the responsible persons who (1) Can respond to the alarm after notification, (2) Are knowledgeable in the basic operation of the alarm system, and (3) Are authorized and able to gain entry and secure the premise if required.