24 Hour Central Station Monitoring
Alarm Monitoring Information Form
Please provide the information below so that we can transfer to a
Your alarm panel must be connected to a POTS (Plain Old
Dealer Name (if applicable)
Receiver/Account Number
(if known)
Name (Last, First)
Street
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconson
Wyoming
State
Zip
Email Address
Location Telephone Number
This is the telephone number the
Central Station will call to
"verify" the alarm before dispatch
Panel Telephone Number
This is the telephone
contacted to the panel - may
be the same as Location
Telephone number.
Alarm Panel Model
Special Instructions
Passcode/Passwor
d
This is the passcode you
will give to the Central
Station to
prove
you are
the subscriber.
Special Options
(commercial)
Open/Close Reporting
24-Hour Supervised Test
GSM
MAC - Located on GSMVLP box
Special Options
(cellular)
Zone Number
Zone Description
Police
Fire
Zone 1
Zone 2
Zone 3
Zone 4
Zone 5
Zone 6
Zone 7
Zone 8
Zone 9
Zone 10
Zone 11
Zone 12
Zone 13
Zone 14
Zone 15
Zone 16
Zone 17
Zone 18
Zone 19
Zone 20
Zone 21
Zone 22
Zone 23
Zone 24
Zone 25
Zone 26
Zone 27
Zone 28
Zone 29
Zone 30
Zone 31
Zone 32
Zone 33
Zone 34
Zone 35
Zone 36
Zone 37
Zone 38
Zone 39
Zone 40
Zone 41
Zone 42
Zone 43
Zone 44
Zone 45
Zone 46
Zone 47
Zone 48
Zone 49
Zone 50
Zone 51
Zone 52
Zone 53
Zone 54
Zone 55
Zone 56
Zone 57
Zone 58
Zone 59
Zone 60
Zone 61
Zone 62
Zone 63
Zone 64
Subscriber Contacts
These are the people (may be yourself) that the Central Station will attempt to reach should
your panel signal an alarm.
Contact Name 1
Telephone Number
Contact Name 2
Telephone Number
Contact Name 3
Telephone Number
Authorities
Please provide the telephone numbers for your local authorities. Do
NOT
use 911.
Police Department
Telephone Number
Fire Department
Telephone Number
Medical
Telephone Number
We will snail-mail you a hardcopy of the
Central Station Monitoring Agreement for
signature based upon the information you
have provided.
Copyright 2011
Vanguard Security Corporation
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