Contact CSC – Commercial 1Contact Information2Signal Verification3Emergency Call List Please check one* Existing New Account Site Name* Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Site Phone Number*Ex. (###) ###-####Secondary Phone NumberEx. (###) ###-####Email Address* Nature of Business Number of stories/floors in the business facility* What floor is the business on? Open / Close Reports Monthly Weekly Email for report delivery OptionalResponding Agencies:Police Dept. (Name) Police Dept. (Name)Police Phone (Not 911) Police Phone (Not 911)Permit Number Permit NumberFire Dept. (Name) Fire Dept. (Name)Fire Phone (Not 911) Fire Phone (Not 911)Permit Number Permit NumberEMT (Name) EMT (Name)EMT Phone (Not 911) EMT Phone (Not 911)Permit Number Permit NumberSecurity Guard Security GuardSecurity Guard Phone Security Guard Phone Fire, Medical, Hold-up and Panic Alarms will be dispatched upon receipt of the signal in the monitoring station. Burglary Alarms will be handled as you designate below:Please select ONE of the following procedure options below that you would like CSC to follow in the event we receive a Burglary Alarm signal.* Single-call VerificationCSC will call the primary contact listed below prior to dispatching the authorities. If no answer or no password/incorrect password is provided, CSC will dispatch the Police Department and continue calling the remaining emergency numbers/contacts you have supplied below, until a live person is reached. Two-call VerificationCSC will call the primary contact listed below. If there is no response, CSC will attempt to call the second contact provided before dispatching authorities. If there is no answer or they fail to provide the correct password, CSC will dispatch the proper authorities and continue calling the remaining emergency contacts you have listed below until a person is reached. Primary Business Phone Number*Ex. (###) ###-####You will fill out your businesses emergency call list on the next page.Important: If you accidentally set off your alarm, please call CSC immediately at (317) 543-1300 For your safety, you must provide your chosen password to CSC when an alarm is reported; failure to give your (correct) password may result in authority response. CSC is not responsible for fines from your local authorities due to a false alarm. We urge you to test your system frequently. If you are having any issues, please contact our Service Department at (317) 543-1300. First Contact Name* First Contact Phone*Alternate PhonePassword* 4-digit Arm/Disarm #* Authorized to make changes* Yes No Second Contact Name* Second Contact Phone*Alternate PhonePassword* 4-digit Arm/Disarm #* Authorized to make changes* Yes No Third Contact Name* Primary Phone*Secondary PhonePassword* 4-digit Arm/Disarm #* Authorized to make changes* Yes No Add Fourth Contact add Fourth Contact Name Primary PhoneSecondary PhonePassword 4-digit Arm/Disarm # Authorized to make changes Yes No Add Fifth Contact add Fifth Contact Name Primary PhoneSecondary PhonePassword 4-digit Arm/Disarm # Authorized to make changes Yes No Add Sixth Contact add Sixth Contact Name Primary PhoneSecondary PhonePassword 4-digit Arm/Disarm # Authorized to make changes Yes No Add Seventh Contact add Seventh Contact Name Primary PhoneSecondary PhonePassword 4-digit Arm/Disarm # Authorized to make changes Yes No Add Eighth Contact add Eighth Contact Name Primary PhoneSecondary PhonePassword 4-digit Arm/Disarm # Authorized to make changes Yes No Add Ninth Contact add Ninth Contact Name Primary PhoneSecondary PhonePassword 4-digit Arm/Disarm # Authorized to make changes Yes No Add Tenth Contact add Tenth Contact Name Primary PhoneSecondary PhonePassword 4-digit Arm/Disarm # Authorized to make changes Yes No I understand that it is my responsibility to contact the local police authority to apply for and obtain any alarm license and/or alarm permit as required. SignaturePrinted Name* Title Password* Please provide your chosen password in the designated space so we may properly identify you as an authorized user on this account.Date Signed* MM slash DD slash YYYY By signing this document, I authorize/agree that all of the information provided is accurate and up-to-date.Please notify CSC via records@central-security.com if your call list information changes so we can continue to effectively serve and protect you.
