DUXBURY FIRE DEPARTMENT
GENERAL BUSINESS INFORMATION FORM
BUSINESS NAME: ____________________________________________
STREET ADDRESS: ____________________________________________
TELEPHONE: _____________________
FLOOR LEVEL (IF NOT FIRST FLOOR): _______________
BUSINESS OWNER: ___________________________________________
RESIDENTIAL ADDRESS: _______________________________________
CITY/TOWN: ____________________________ STATE: ____________
ZIP CODE: _________________
MANAGER/2ND CONTACT: _______________________________________
RESIDENTIAL ADDRESS: ________________________________________
CITY/TOWN: _____________________________ STATE: ____________
ZIP CODE: _________________
BUILDING OWNER: _____________________________________________
RESIDENTIAL ADDRESS: _________________________________________
CITY/TOWN: _____________________________ STATE: _____________
ZIP CODE: __________________
FIRE ALARM SYSTEM: ___________ SPRINKLER SYSTEM: ____________
CENTRAL STATION NAME: _______________________________________
TELEPHONE #: _______________
FIRE DEPARTMENT CONNECTION LOCATION: ______________________
DO YOU HAVE A LOCK BOX: _______________
CONTACT PERSONS OR OTHER KEY HOLDERS, IF PROBLEM WITH ALARMS
NAME: ___________________________________________
TELEPHONE: _____________________
NAME: ___________________________________________
TELEPHONE: _____________________
OTHER COMMENTS:
CONTACTS IN CASE OF EMERGENCY
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