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Business Emergency Contact Form
In an effort to better serve you we continuously update our department files, including all emergency contact information for commercial businesses in the town of Holland. The purpose of having this information is so that we can contact you or your selected representative in case an emergency situation or an incident involving the police department arises at your business after hours of operation. The information that you provide us will be entered into our department computer system as emergency contact information and not decimated to the public, however a copy of the information will be forwarded to our dispatch center (New Braintree Regional Dispatch) for their records.





Business Name: _______________________________________________________________________

Street Address: ________________________________________________________________________

Business Phone: _______________________________________________________________________


Fire Alarm YES / NO      Burglar Alarm YES / NO


Name of alarm company:  ___________________________
                                                (If applicable)

Phone Number:                   ___________________________
                                                 (If applicable)                                                 





Primary Contact: _____________________________ Title:_____________________________

Home Address:   _________________________________

City/State/Zip:         _________________________________

Home Phone:     _________________________________

Cell/Work/Pager:        _________________________________





Alternate Contact: _____________________________ Title:_____________________________

Home Address:   _________________________________

City/State/Zip:         _________________________________

Home Phone:     _________________________________

Cell/Work/Pager:        _________________________________



 
Town of Holland 27 Sturbridge Road, Holland, MA 01521
Phone: 413-245-7108 Fax: 413-245-7037
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