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NEW HAMPSHIRE ALARM ASSOCIATION
A Chartered State Association of the National Burglar and Fire Alarm Association

MEMBERSHIP APPLICATION FORM

Company Information
 Your Name:
 Company Name:
 Address:
 City:  State:  Zip:
 Phone:
 Fax:
 Email:
 Web URL:

Types of Services Offered
Central Station - Burglar Central Station - Fire
Local Station - Burglar Local Station - Fire
Police Connect Proprietary Alarm Service
Access Control CCTV
Other: (Describe)

Is Your Company UL Listed?

No   Yes - To standards below:



Do You Operate a 24-Hour In-House Central Station?

No   Yes


(Answer if Applicable) Is Your Central Station:
UL Listed for Burglar?UL Listed for Fire?
No    Yes No    Yes


Company Officers/Principals:
 Name:
 Title:

 Name:
 Title:


General Information:
Have any of the officers/principals ever been convicted of a felony?
No    Yes - Explain below:



Do You Perform Employee background Checks?
No    Yes


Dues and Fees:
# of Employees
NHAA
NBFAA
TOTAL
1-5
$100
$228
$328
6-10
$100
$390
$490
11-15
$100
$520
$620
16-25
$100
$715
$815
26-50
$100
$1333
$1433
51-100
$100
$1723
$1823
101-150
$100
$2503
$2603
151 +
$100
$3283
$3383

NBFAA Prorated Dues Amounts Calculated by Join Date

January 1 - March 31 0 % First Quarter
April 1 - June 30 25% Second Quarter
July 1 - September 30 50% Third Quarter
October 1 - November 15 75% Fourth Quarter

Please Mail Check for Total Amount Due to:

New Hampshire Alarm Association
PO Box 187
Pelham, NH 03076

Please make checks payable to New Hampshire Alarm Association.
Also enclose your business card.

Last updated and validated November 7, 2007