2. 
3. La Vista Police Department Emergency Business Contact Information Form
5. Date Obtained/Submitted*
7. Business Name*
9. Hours of Operation*
11. Street Address*
13. Business Phone Number(s)*
15. Owner/Manager*
16. Phone Number*
19. Phone Number*
21. Emergency Contact*
22. Phone Number*
25. Phone Number*
27. Emergency Contact*
28. Phone Number*
31. Phone Number*
33. Alarm Company*
34. Phone Number*
36. Occupants After Hours*
38. Toxic Chemicals, Flammable Materials or Explosives*
40. Security Cameras
41. Interior*

    1. Yes
    2. No
42. Exterior*

    1. Yes
    2. No
44. Location of Fire Hydrants*
46. Location of Electrical Panel*
48. Location of Gas Meter*
50. Location of Sprinkler Hookup*
52. Location of Standpipe Hookup*
54. Remarks
Leave This Blank:


55. 1. Receive an email copy of this form.
56. Email address

    This field is not part of the form submission.

57. Submit

* indicates a required field