Alarm and Night Call Form Alarm Form Business Name * Business Street Address (Please provide full 911 address) * Business City * Business County * Business State * Business Zip * Business Phone Number * Business Email Owner/s Name/s * Night Call Please provide 3 to 4 night call names and phone number to be contacted in case of emergency or security concern situations. Please list in order that you wish them to be contacted. NAME PHONE NUMBER Add Remove If you have a security alarm installed in your business please give us the name and phone number of the company. Alarm Company Phone Number ***If there are any hazmat materials in your business, check here: * HAZMAT MATERIALS PRESENT No Name and Signature of person filling out this form Name * Signature Clear Submitting this form will send a copy to the Madison County Sheriff and to the email address filled in above. You may print a copy for your own records after submittal. Submit
