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4. Attention Business Owner / Manager:

   The following emergency contact sheet is being sent to you because the information on file at the Twinsburg Police Department is out-dated.

   There may be a need at times, during an emergency, where a member of the Twinsburg Police or Fire Departments may need to contact someone from your business. Keeping updated information on file also ensures business security, and helps us verify anyone we may encounter after hours.

   If you have any questions regarding the integrity of this request, please feel free to contact us at: (330) 425-1234.

   If you received a paper copy of this form, please print legibly and then fax the completed form to: (330) 487-0890. You

   may also return the form by mail to: Twinsburg Police Department, 10075 Ravenna Road, Twinsburg OH 44087.

   If you received an electronic copy of this form, please complete the form, save it, and then email a copy to cfried@twinsburg.oh.us If you would like to receive an electronic copy, please email your request to the same address.

   If your business has changed names, or does business as more than one name, please include that information on the sheet provided. Feel free to make copies of this so you can keep us updated on any changes that may take place within your company. Thank you.

   Chris Fried

6. Company Name*
8. Address*
10. Business Phone Number*
11. Fax Number
13. Email Address*
15. Hours of Operation*
17. Nature of Business*
19. Owner/Manager Name*
20. Owner/Manager City of Residence
22. Owner/Manager Primary Phone Number*
23. Owner/Manager Secondary Phone Number
25. Is the Building Alarmed?*

    1. No
    2. Yes
26. Please provide Alarm Company Name
27. Provide Alarm Company Phone Number
29. Landlord/Property Owner Name*
30. Landlord/Property Owner Phone Number
32. Does the company use or store materials which might present a hazard to officers or firefighters responding to an emergency?

    1. No
    2. Yes
34. If yes, please indicate type of hazard

36. Emergency Contacts
    List in order of preferred contact
    
    

38. First Name*
39. Last Name*
40. City of Residence*
41. Phone Number*
43. First Name*
44. Last Name*
45. City of Residence*
46. Phone Number*
48. First Name
49. Last Name
50. City of Residence
51. Phone Number
53. First Name
54. Last Name
55. City of Residence
56. Phone Number
Leave This Blank:


58. 1. Receive an email copy of this form.
59. Email address

    This field is not part of the form submission.

60. Submit Submit and Print

* indicates a required field