The City of Independence - Business Emergency Information Form

Independence, Kentucky Police
Business Emergency Information Contact Form

If you are a business owner and would like the Independence Police Department to hold contact information in case of an emergency please fill out the form below as complete as possible.
* denotes a required field.

Business Name:

*

Address of Business Property

*

Suite #

Business Phone Number:

*

Owner's cell phone Number
(with area code)

*

Your e-mail:

*

Owner's Name

*

Owner's Home Address

*

Your IP Address:

List up to 3 persons in order of importance to contact in case of an emergency

	Name & Relation	Address	Phone Number
1
2
3

Alarm System:

Yes No

Type of alarm:

Burgler Hold Up Fire

Alarm is:

Silent Audible

Alarm Company:

Alarm Company Telephone:

If there is any after hour lighting please describe and be as specific as possible:

All other information including friends or relatives checking the house, feeding pets, collecting mail or newspapers, and etc.

Independence Police
5409 Madison Pike
Independence, Ky. 41051
phone: (859) 356-2697
fax: (859) 363-4840

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