Agent Application

Any individual employed in the business of installation or service of fire alarm or sprinkler systems may apply to be listed as a CITYWIDE Master Fire Alarm Box Listed Agent in the City of Manchester, NH. Any individual designated by a property owner and has a working knowledge of the operation of the Fire Alarm System may be listed as PROPERTY Master Fire Alarm Box Listed Agent in the City of Manchester, NH. All applicants will be required to complete any application, attend and successfully complete a training class conducted by the Manchester Fire Department. After the application has been reviewed and verified each applicant will be scheduled for a training class.

A listing shall remain in effect until the individual no longer meets the requirements for a listing OR has violated the requirements of the Manchester Fire Department for Master Fire Alarm Box Listed Agents. Listed agents are responsible for notifying the Communications Division of changes in employment, telephone, and pager.

I have received a copy of the rules and agree to abide by such AND that any violations of the Rules & Regulations will result in loss of Listed Agent Status.

"*" indicates a required field.

Agree to Terms *	I agree to all rules and regulations
Application to be listed for * :	Citywide Property
Company Name
Position
Company Street Address *
Company City *
Company State *
Company Zip *
Company Phone Number *
Fax
Agent First Name *
Agent Last Name *
Pager No.
Agent Street Adress *
Agent City *
Agent State *
Agent Zip *
Agent Home Phone *
Agent Cell
Email *
Identify type of lock used on your box(s)	Barrel Flat Both
Name of property:
Property Address:
Owner's Name:
Owner's Street
Owner's City
Owner's State
Owner's Zip
	Submit Cancel