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City of Washington, NC
Application for Business Privilege License
Washington Police Emergency Contact Information Form
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Any information gathered on this form is confidential and will only be used for official purposes by the Washington Police Department.
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Instructions: Please fill out this form completely. Please PRINT very clearly and neatly in ink. |
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| DATE: |
BUSINESS NAME: |
| ADDRESS OF BUSINESS: |
| MAIN PHONE NUMBER OF THE BUSINESS: |
_________________________________________
INCLUDE AREA CODE
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EMERGENCY CONTACT INFORMATION**
This is a list of people that the POLICE can call in case of an emergency.
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| 1. NAME: |
PHONE #: __________________________
INCLUDE AREA CODE
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ADDRESS: __________________________________________________________________________
STREET ADDRESSES ONLY - NO P.O. BOXES |
| 2. NAME: |
PHONE #: __________________________
INCLUDE AREA CODE
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ADDRESS: __________________________________________________________________________
STREET ADDRESSES ONLY - NO P.O. BOXES |
| 2. NAME: |
PHONE #: __________________________
INCLUDE AREA CODE
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ADDRESS: __________________________________________________________________________
STREET ADDRESSES ONLY - NO P.O. BOXES |
| **Please attempt to identify three (3) people that can be contacted and who have 24-hour access to the business. |
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ROUTING INSTRUCTIONS: Please forward this to the Washington Police Department without delay.
Street Address: 201 West Third Street
Mailing Address: P.O. Box 1988, Washington, NC 27889
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