Alarm Monitoring Authorization Form

Basco Security Alarm Monitoring Authorization

Name(Required)

First Last

Account Number(Required)

Address(Required)

Street Address City State ZIP Code

Phone(Required)

Additional Phone

Authorized By:(Required)

First Last

Authorization Date(Required)

Authorized By: (Signature)(Required)

Keyholder Information

Please list below all persons authorized to enter the protected property (starting with you) along with each of their phone numbers, access code and password in order of who would be called on alarm signals.

List(Required)

Keyholder Name

Phone Number

Phone Type

4-Digit Access Code (Touchpad)

Password (If HS Calls)

Optional 4-Digit Duress Code (Emergency touchpad number)

Basco Security Alarm Monitoring Authorization

Keyholder Information

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