Forms • Columbus, NE • CivicEngage

Business Information Sheet

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The Columbus-Platte County Joint Communications Center would like you to take a few minutes to complete the information below.
This data will assist us in the event that we would need to make contact with a business representative after normal business hours.
Please complete and submit the below form.
A phone call will be made to the business to confirm this information. Thank you for your help.

Business Name*

Street Address*

Business Phone Number*

Business Fax Number

Business Email

After Hours Contact(s)

Primary Contact*

Phone*

Alternate Contact

Phone

Alternate Contact

Phone

Hazards on site (hazardous materials, animals on site, etc)

Is your business equipped with an alarm system*

Yes

Alarm Company Name and Phone Number

Please indicate where your entrances/exits are located*

Hours of operation*

Special Instructions for Police/Emergency Services

* indicates required fields.

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