Emergency Keyholder Contact Information

Business Name(Required)

Address(Required)

Street Address

Mailing Address (if different than the street address)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone(Required)

Country Phone Number

Email(Required)

Website

Type of Business and/or Main Product Produced(Required)

Seasonal(Required)

Yes

In the box below, please provide your business hours Sunday-Saturday along with any other addition business information.(Required)

Maintenance/Cleaning Service on Premises After Hours

Name (Include Business Name)(Required)

Title(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone(Required)

Country Phone Number

License Plate Number(Required)

Time of Day on Premises(Required)

Other Pertinent Information About Your Business

Please list any information that would be helpful to emergency personnel, such as location of hazardous materials, used and/or stored, disabled individuals on premises, fire alarm panel or location of emergency lighting controls.

Keyholder/Owner Information

The information on this form will be used by the Slinger Police Department in the event of an emergency or incident, during non-business hours at your place of business. If you have more than one contact, please fill out as many forms as you need.

Name(Required)

First Last

Title(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone(Required)

Country Phone Number

Response Time in Minutes(Required)