Tcomm 911 Premise Form
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1TCOMM 911 PREMISE FORM
Type or Print Legibly
Date:________
Name:_______________________________
Position/Title:________________________
Business Name:________________________________________________________________
Address: (Include directional and suite # if applicable. Ex: 1234 Main St SE #4, Olympia)
______________________________________________________________________________
If this business has moved, please list previous address:
______________________________________________________________________________
Business Phone: (
)
.
After Hours Emergency Call-Out Information:
Please list ONLY those with access to the premise.
Please include area codes with telephone numbers.
First Name
Last Name
Primary Phone
Secondary Phone
1.
2.
3.
4.
Building Owner & Phone
_________________________________________________
(if different)
Alarm Company(s):_________________________________ Phone:_____________________
Provide information you wish emergency personnel to have to reach you or find your business such as: gate codes,
directions if difficult to find, Knox box locations, etc. (Please note we cannot accept hidden key information or gate
codes for private residences)
Instructions: Call 360 704 2740 to have the completed form picked up by a Public Safety Representative.
Alternately, bring the completed form to your Public Safety Agency. Do not fax or mail to TCOMM 911.
Verified By: _____________________________________________________ (Public Safety Name/ID# required)
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Parent category: Life