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Business Owners Emergency Night-Call Info

2. Cowlitz 911 requests your cooperation in helping us better serve you as a Cowlitz County business owner. Providing the following information will provide us with the tools we need to attempt to inform you of situations that impact your business after your business has closed. This information is treated as confidential and is not released to the public.

4. First Name of the Person Completing this Form*

5. Last Name of the Person Completing this Form*

7. What is your position with this business (i.e., your job title)?*

9. Full Business Name*

11. Full Business Address*

    Physical Address of the Business

13. City*

14. State*

15. Zip Code*

17. Business Phone*

    Answered During Business Hours

18. Business Phone (Unpublished)*

    Answered After Business Hours

20. Night-Call Information
    Please list your personnel in the priority order you wish them to be contacted for issues involving your business AFTER hours.

    Please list your personnel in the priority order you wish them to be contacted for issues involving your business AFTER hours.

22. #1 First Name*

23. #1 Last Name*

24. #1 Home Phone*

    Include Area Code

25. #1 Cell Phone*

    Include Area Code

27. #2 First Name

28. #2 Last Name

29. #2 Home Phone

    Include Area Code

30. #2 Cell Phone

    Include Area Code

32. #3 First Name

33. #3 Last Name

34. #3 Home Phone

    Include Area Code

35. #3 Cell Phone

    Include Area Code

37. #4 First Name

38. #4 Last Name

39. #4 Home Phone

    Include Area Code

40. #4 Cell Phone

    Include Area Code

42. #5 First Name

43. #5 Last Name

44. #5 Home Phone

    Include Area Code

45. #5 Cell Phone

    Include Area Code

47. NOTE: Remember to update any changes to your business night-call information as soon as the change occurs.

Leave This Blank:


49. 1. Receive an email copy of this form.
50. Email address

    This field is not part of the form submission.

51. Submit Submit and Print

* indicates a required field