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2. 
4. Type of Alarm:*

   1. Burglary

   1. Hold-Up

   1. Fire

   1. Medical
6. First Name:*
7. Last Name:*
9. Alarm Site House Number:*
10. Alarm Site Street Name:*
11. Alarm Site Street Type:*
12. Alarm Site Apt Number:
14. Alarm Site City:*
15. State:
16. Alarm Site Zip:
20. Is there a different billing address?*

    1. Yes
    2. No
22. House Number:*
23. Street Name:*
24. Street Type:*
25. Apt Number:
27. City:*
28. State:*
29. Zip:*
31. Permit Holder Last Name:*
32. Permit Holder First Name:*
33. Permit Holder Middle Name:
35. Permit Holder Phone Number #1:*
36. Permit Holder Phone Number #2:
38. Permit Holder Driver's License State:*
39. Permit Holder Driver's License Number:*
41. Permit Holder E-Mail:
42. Alarm Monitoring Company:*

46. Emergency Contact Information - 2 Required (Residential and Business):

48. Contact 1 First Name:*
49. Contact 1 Last Name:*
51. Contact 1 Address 1:*
52. Contact 1 Address 2:
54. Contact 1 City:*
55. Contact 1 State:*
56. Contact 1 Zip:*
58. Contact 1 Phone Number #1:*
59. Contact 1 Phone Number #2:
63. Contact 2 First Name:*
64. Contact 2 Last Name:*
66. Contact 2 Address 1:*
67. Contact 2 Address 2:
69. Contact 2 City:*
70. Contact 2 State:*
71. Contact 2 Zip:*
73. Contact 2 Phone Number #1:*
74. Contact 2 Phone Number #2:

76. The permit is renewed yearly.  It is the responsibility of the permit holder to ensure that the permit is renewed.  Cancellation of a permit must be made in writing and submitted to the address or fax number below. 

    I have read the completed application and know the same is true and correct and hereby agree that if a permit is issued, I will comply with all provisions of the City Code 2011-01-0325O, and applicable State laws.  I accept responsibility for payment of all fines that may result from the operation of the alarm serving the above alarm site address.  If you have any questions, please contact the Oak Forest Police Department at 708-687-1376 or fax at 708-687-6218.

78. AGREEMENT:  By signing this Electronic Signature Acknowledgment Form, I agree that my electronic signature is the legally binding equivalent to my handwritten signature. Whenever I execute an electronic signature, it has the same validity and meaning as my handwritten signature. I will not, at any time in the future, repudiate the meaning of my electronic signature or claim that my electronic signature is not legally binding.

    Electronic Signature:

80. Please type your First and Last Name:*
81. Date:*
    Date:
83. Legal Signature:*

    1. I Understand

    I understand that checking this box constitutes a legal signature confirming that I acknowledge and warrant the truthfulness of the information provided in this document.

Leave This Blank:


89. 1. Receive an email copy of this form.
90. Email address

    This field is not part of the form submission.

91. Submit

* indicates a required field