Emergency Contact Form

All businesses in Fayette County should submit their Emergency Contact information to Fayette County 911.

Any time there is an update, the information should be resubmitted.

*Required Fields

*Is this an update to previously submitted information?
Yes, I have submitted this information online before.
No, this is the first time I have submitted this information online.

Business Information

* Name of Business:
* Business Address: Suite: * Required if applicable

* City:

* State:

* Zip Code:

* Business Phone Number:

Business Fax Number:

Prior Address of Business (if applicable):

If your business has moved from a location in Fayette County (incorporated or unincorporated) to another location in Fayette County (incorporated or unincorporated) please enter the previous address.

Suite: * Required if applicable

City:

State:

Zip Code:

When did the business move?

Emergency Contact Information

This is someone who can gain access to the business after normal business hours in case of: Fire, Burglar Alarm or other emergency situations. Please list the emergency contacts and their phone numbers in the order in which you would like them called. If the emergency contact has more than 2 phone numbers please add the contact name again with the additional numbers.

* Emergency Contact Name:

* Contact Phone Number:

Type:

Secondary Phone Number:

Type:

Business Owner Information

* Business Owner(s) Name:

Please list the phone numbers in the order in which you would like them called.

* Owner(s) Phone Number:
(Emergency Use Only)

Type:

Secondary Phone Number:

Type:

Building Owner Information

Building Owner(s) Name:

Contact Phone Number:

Type:

Secondary Phone Number:

Type:

* Email:

Please provide an email address to receive a confirmation that your information was submitted and for possible reminders in the future.

Additional Comments:

Emergency Contact Form

Business Information

Emergency Contact Information

Business Owner Information

Building Owner Information

I WANT TO:

TAKE ME TO: