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  1. Purpose
    This form is designed to collect information that will be used only by Butler County Emergency Communications and the local response agencies we serve to better respond to any potential emergencies at your business. This information will not used for any purpose other than public safety.
  2. During business hours
  3. Primary Contact Person
    Enter the name and contact information for the first person to be contacted in case of an emergency.
  4. Enter the name of the first person to be contacted in the event of an emergency.
  5. Business Owner
  6. Second Contact Person
    Enter the name and contact information for the person to be contacted if the primary contact cannot be reached.
  7. Business Owner
  8. Third Contact Person
    Enter contact information for the person to be contacted as a last resort.
  9. Business Owner
  10. Please add any gate/door codes or combinations to allow responding units with after-hours access.
  11. To Change or Update this Information in the Future...
    ...pleases return and complete this form again. Thank You!
  12. Leave This Blank:

  13. This field is not part of the form submission.