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alem County GateKeeper Form
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Salem County Department of Emergency Services
GateKeeper Program
Date:*
Business Name:*
Business Address:*
Business Phone Number:*
Business Fax Number:*
Business Email Address:*
Hours of Operation:*
Cross Streets:*
Description of Building:*
After hours cleaning crew?Yes   No  
If yes, Company Name:
Company Phone Number:
Cleaning Hours:
Do you have an alarm system?Yes   No  
Type:Fire   Burglar   Panic  
If yes, Alarm Company Name:
Alarm Company Phone Number:
Is the alarm audible to the exterior?Yes   No  
Is the alarm self-resetting?Yes   No  
Building Owner Name:
Building Owner Address:
Building Owner Phone Number:
Building Owner Fax Number:
Business Owner Name:
Business Owner Address:
Business Owner Phone Number:
Business Owner Fax Number:
Keyholder Information - 1) Name:
1) Cell Number:
1) Home Number:
2) Name:
2) Cell Number:
2) Home Number:
3) Name:
3) Cell Number:
3) Home Number:
4) Name:
4) Cell Number:
4) Home Number:
Right to Know Central File:Yes   No  
If yes, where:
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