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2. Resident Contact Information
4. First Name*
5. Last Name*
7. Street Address *
   You do not need to enter city, state, or zip code.
9. Phone Number*
10. Email Address*
12. I would like to:*

    1. Add New Contact
    2. Remove a Contact
    3. Update Subscriber Information
    4. Update Emergency Contact Information
14. Note:
    Please input the information of the contact you would like to add, remove, or update.
16. First Name
17. Last Name
19. Address1
21. Address2
23. City
24. State
25. Zip
27. Phone Number
28. Relationship to Subscriber
30. First Name
31. Last Name
33. Address1
35. Address2
37. City
38. State
39. Zip
41. Phone Number
42. Relationship to Subscriber
44. Update Resident Information Only
46. First Name
47. Last Name
49. Current Number
50. Type

    1. Home
    2. Cell
    3. Work
51. New Phone Number
52. Type

    1. Home
    2. Cell
    3. Work
54. First Name
55. Last Name
57. Current Number
58. Type

    1. Home
    2. Cell
    3. Work
59. New Phone Number
60. Type

    1. Home
    2. Cell
    3. Work
62. Mobile App - Remotely manage your system via alarm.com mobile app. *

    1. Yes! Sign me up for alarm.com!*

    *For compatible systems and an additional fee. To check compatibility, please contact your alarm technician.
64. Alarm.com Package Options*

    1. Interactive Gold - an additional $8.95/month: Remote Arming/Disarming, Sensor Activity Monitoring, Unexpected Activity Alerts, User Code Management, Customized Email/Text Message Notifications

    1. Interactive Gold + Pro Video - an additional $14.95/month: Everything included with Interactive Gold AND Pro Video with Analytics 3000: 4 cameras, 3000 clips (online/uploads), Video Analytics

    *For compatible systems and an additional fee
66. I authorize West University Place Police Department to create an alarm.com account as indicated by providing an email address of the primary alarm.com account holder
    The West University Place Police Department manages subscriptions only. Equipment is not included (please ask your service technician about purchasing or servicing compatible equipment).
68. City of West University Place Other Provisions
    City of West University Place Other Provisions

    Please read and acknowledge the City of West University Place Provisions
70. First Name*
71. Last Name*
Leave This Blank:


73. 1. Receive an email copy of this form.
74. Email address

    This field is not part of the form submission.

75. Submit Submit and Print

* indicates a required field