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2. Emergency Contact Form for Local Business Owners

   In the event of an emergency or incident requiring immediate action by a business owner, the Emergency Contact Form for Local Businesses allows Cumberland Public Safety personnel the ability to quickly contact those responsible for the businesses in town. Should any information you submitted in this form change, please fill out a new form as soon as possible so all information in our system is current and the correct people are notified in a timely manner.

   All forms, when submitted, will require a Public Safety Dispatcher to call the primary contact listed to verify the information provided.

4. Business Name*
6. Business Address*
7. Suite/Unit/Building
9. Building Owner Name*
11. Home Phone Number
12. Cell Phone Number*
14. Primary Point of Contact Name*
16. Primary Point of Contact Home Number
17. Primary Point of Contact Cell Number*
19. Secondary Contact Name*
21. Secondary Contact Home Number
22. Secondary Contact Cell Number*
24. Is there an alarm system?*
    -- Select One --YesNo
25. Type of Alarm*

    1. Burgler
    2. Fire
    3. N/A
27. Alarm Company Name
28. Alarm Company Phone Number
30. List any building hazards or hazardous chemicals/materials stored on site:*
Leave This Blank:


32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit

* indicates a required field