Business Emergency Contact Request Form

2. We are looking for up-to-date contact information for your business to be used when emergency services are called after your operational hours in the case of an alarm activation or incident occurs.

   
   

   This information will be used to add/update your businesses contact information for Wyoming County's 9-1-1 Dispatch to use in the case of an emergency. 

6. Business Name*
8. Business Address*

   Street, Town, State, and Zip Code

10. Business Hours of Operation
12. (1) Emergency Contact Name*
13. (2) Emergency Contact Name
14. (3) Emergency Contact Name
16. (1) Emergency Contact Phone Number*
17. (2) Emergency Contact Phone Number
18. (3) Emergency Contact Phone Number
20. Any additional information.

22. All disclosed information will remain confidential and only shared with Wyoming County 9-1-1 Dispatch system for emergency response purposes.

Leave This Blank:


23. 1. Receive an email copy of this form.
24. Email address

    This field is not part of the form submission.

25. Submit

* indicates a required field