TOWN OF PARKER 
POLICE AND FIRE DEPARTMENT INFORMATION 
DATE 

 (THIS FORM IS TO BE FILLED OUT BY ALL COMMERCIAL BUSINESSES LOCATED IN PARKER) 
NAME OF LOCAL BUSINESS (Physical Name on Outside of Building) LOCAL BUSINESS PHONE NUMBER 
 
BUSINESS LOCATION ADDRESS (No PO Box) CITY STATE ZIP + 4 

BUSINESS OWNER NAME HOME PHONE NUMBER  (Confidential) 

BUSINESS OWNER HOME ADDRESS (Confidential) CITY STATE ZIP + 4 

Business Information
NORMAL OPENING TIME (Confidential) NORMAL CLOSING TIME (Confidential) EXCEPTIONS TO NORMAL TIMES 
(Confidential) 

LIST THREE PERSONS IN THE ORDER THAT YOU WANT THEM CALLED IN THE EVENT OF AN EMERGENCY: (Confidential) 
1) NAME TITLE ADDRESS CITY PHONE 

2) NAME TITLE ADDRESS CITY PHONE 

3) NAME TITLE ADDRESS CITY PHONE 
 
DO YOU HAVE AN ALARM? Yes No IS THE ALARM SILENT OR AUDIBLE? Silent Audible 
 
IS THE ALARM U/L APPROVED? Yes No IF SO, WHAT TYPE OF ALARM? Burglar Holdup Fire 
NAME OF ALARM ADDRESS OF ALARM COMPANY CITY STATE ZIP PHONE 
COMPANY NUMBER 

LOCATION OF SAFE LOCATION OF LIGHTS LEFT ON LOCATION OF MAIN WATER SHUTOFF 
Emergency Information

 KNOXBOX LOCATION 
DO YOU HAVE A KNOXBOX?   Yes   No 

REMARKS:  (List any possible hazards to Police or Fire personnel) 

Rev. 3.9.16