STROUD TOWNSHIP MUNICIPAL CENTER
1211 NORTH FIFTH STREET
STROUDSBURG, PA 18360-2646
570-421-3362
ALARM REGISTRY FORM

INITIAL REGISTRY FEE:
Residemtial  $20.00
Commercial $50.00
(Make check payable to Stroud Township)

DATE:
ALARM OWNER:
BILLING ADDRESS:
PHYSICAL ADDRESS:
LOCAL HOME NUMBER: BUSINESS/WORK PHONE NUMBER:

LOCAL CONTACT NAMES OUT OF TOWN CONTACT NAMES
NAME: NAME:
PHONE: PHONE:
NAME: NAME:
PHONE: PHONE:

DIRECTIONS TO YOUR ALARM LOCATION:


PHYSICAL DESCRIPTION OF ALARMED PREMISE:
TYPE OF SYSTEM BURGLARY FIRE SMOKE MED ALERT MCCC*
NAME AND 800 NUMBER OF ALARM COMPANY:

SIGNATURE ___________________________________________________________________________

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ALARM PERMIT NUMBER DATE RECEIVED FEE PAID____________
_______________________ ___________________ CHECK # ____________
UPDATE _______________ UPDATE ___________ UPDATE _____________

* YEARLY FEE WILL BE BILLED ON THE ANNIVERSARY MONTH OF YOUR INITIAL REGISTRY. Renewals: Residential $10.00; Commercial $25.00
** MCCC- THIS MEANS THAT YOUR ALARM SYSTEM IS TIED IN DIRECTLY TO THE MONROE COUNTY CONTROL CENTER FOR THEM TO MONITOR.

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