FAIR LAWN POLICE DEPARTMENT

Business / Emergency Contact Information

Business Information

Business Name: ________________________________________________

Business Address:  ____________________________________ Suite #  ___

Business Phone #:  ______________________________________________

Alarm Information

Alarm Monitoring Company:  _____________________________________

Monitoring Company Phone #:  ____________________________________

Emergency Contact(s)

1.  Owner/Manager:  _____________________________ Cell #___________

 Address:  ______________________ City:  _________________ State:  ____

 2.  Name:  _______________________________ Cell #:  _________________

 Address:  _________________________ City:  ______________ State:  ____

 3.  Name:  _______________________________ Cell #:  _________________

 Address:  _________________________ City:  ______________ State:  ____

 4.  Name:  _______________________________ Cell #:  _________________

 Address:  _________________________ City:  ______________ State:  ____

 **** Please FAX this form to the FLPD at 201-475-0882 ****