LOCKBOX APPLICATION
PHARR FIRE DEPARTMENT
Applicant Information
The person residing in the home where the lock box will be attached.
Applicant Name
*
First Name
Last Name
Home Phone
*
Please enter a valid phone number.
Cell/Other Phone
*
Please enter a valid phone number.
Date of Birth
*
-
Month
-
Day
Year
Date
Drivers License or ID Number
Physical Address
*
Street Address
Apt. / Suite / Room
City
State / Province
Postal / Zip Code
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Emergency Contact #1 Information
A person we can call if we cannot reach the applicant
Emergency Contact Name
*
First Name
Last Name
Home Phone
*
Please enter a valid phone number.
Cell/Other Phone
*
Please enter a valid phone number.
Date of Birth
-
Month
-
Day
Year
Date
Relationship
*
Name of Workplace
Workplace Phone
Please enter a valid phone number.
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Emergency Contact #2 Information
A person we can call if we cannot reach Emergency Contact #1
Emergency Contact Name
First Name
Last Name
Home Phone
Please enter a valid phone number.
Cell/Other Phone
Please enter a valid phone number.
Date of Birth
-
Month
-
Day
Year
Date
Relationship
Name of Workplace
Workplace Phone
Please enter a valid phone number.
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Additional Information
Please pull all pertinent information you would like dispatch to be able to relay to emergency responders below.
Provide information regarding medical conditions, pets, alarms, or other information the fire department should maintain on file.
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LOCKBOX INFORMATION
Please be accurate and detailed with information below.
General location of Lock Box
*
Front of residence or rear of residence, etc.
Take Photo of Front of Residence
Exact location of Lock Box
*
Window left of front door, water spigot south side of residence, etc.
Take Photo of Exact location of Lock Box
Lock Box Lock Combination
*
The combination used to remove or move the lock box
Lock Box Door Combination
*
The combination used to retrieve key to open residence.
Hazardous Conditions
List any hazardous conditions that first responders may face when accessing this lock box
District
Please Select
District 1
District 2
District 3
District 4
Sector
Please Select
Sector 1
Sector 2
Sector 3
Sector 4
Sector 5
Sector 6
Sector 7
Submit
Should be Empty: