Business Contact Registration

We request that all commercial businesses within the Town of Holland submit this form in order to ensure that public safety officials have the ability contact you if an emergency situation or an incident arises at your place of business after hours of operation. The information that you provide to us will be entered into our department computer system and not disseminated to the public; however a copy may be forwarded to our Dispatch Center, (New Braintree Regional Dispatch), as well as the Holland Fire Department for their records.

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Business Name *

Name of the business

Street Address *

Street address of the business

Phone Number *

Phone number for the business

Alarm Company

Name of alarm company for the business [if applicable]

Primary Contact Name *

Name of primary emergency contact for the business

Primary Contact Address *

Address for primary emergency contact for the business

City-State-Zip *

City, state and zip code

Primary Contact Phone Number *

Phone number for primary emergency contact

Email Address *

Valid email address for primary emergency contact

Alternate Contact Name

Name of alternate emergency contact for the business [if applicable]

Alternate Contact Address

Address of alternate emergency contact for the business [if applicable]

City-State-Zip

City, state and zip code

Alternate Contact Phone Number

Phone number for emergency alternate contact [if applicable]

Additional Information

Add additional information here if needed

Leave this field blank

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Business Contact Registration