The following information will help The Department of Public Safety serve you better in the event of an emergency.

Name of Company:*

Business Phone: *

Owner of Business:*

Business Address:*

E-mail Address:

Contact Person #1:*

Phone:

Cell Phone:

Contact Person #2:

Phone:

Cell Phone:

Contact Person #3:

Phone:

Cell Phone:

Intrustion Alarm:

Yes No Audible only

Monitored Both

If monitored, by whom:

Fire Alarm:

Yes No Audible only

Monitored Both

If monitored, by whom:

Sprinkler System:

Yes

No

Is the Sprinkler System connected to the alarm?

Yes

No

Smoke Detectors:

Yes

No

Are the smoke detectors connectted to the alram?

Yes

No

Entry Point Locations:

Currency left on Premises:

Location of Safe or Valuables:

Weapons on Premises:

Location:

Lights left on in Building:

Location:

Owner of Building:

Address:

Phone:

Date: