Business Emergency Notification Form

Please supply a list of individuals to contact in the event POLICE must respond when no one is at location. List a sufficient number of people so that at least one will always be available. This list should be updated on a Semi-Annual basis or whenever a change occurs. If your business moves to another location, please notify the Police Department.

Date *

Month

Day

Year

Type of Business *

Business Name *

Phone Number *

Address *

Business Email Address *

Website

Billing Address *

Alarm Company

Phone Number

Property Owner/Management Co.

Address

Phone Number

Emergency Contact Person #1 Name *

Emergency Contact Person #1 Phone Number *

Emergency Contact Person #2 Name

Emergency Contact Person #2 Phone Number

Emergency Contact Person #3 Name

Emergency Contact Person #3 Phone Number

Emergency Contact Person #4 Name

Emergency Contact Person #4 Phone Number

Surveillance Camera’s On-site? *

Yes

Location of Cameras

If there are Surveillance Camera’s on-site, are you willing to provide police access to the surveillance footage if necessary for investigative purposes?

Yes

Mall Only

Select appropriate location:

Lower Level

Upper Level

Please list the names of the stores on EITHER SIDE of your store/kiosk, in order to expedite Police response:

Leave this field blank