Town Of Davie - Business Tax Receipt Checklist For Submittals Commercial/industrial Page 5

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DAVIE POLICE DEPARTMENT
1230 S. Nob Hill Road
Davie, Florida 33324
(Telephone) 954-693-8200
(Fax) 954-693-8208
BUSINESS UPDATE SURVEY
CONFIDENTIAL INFORMATION
(Emergency information for use by The Town of Davie Police Department)
BUSINESS NAME: ______________________________________ DATE: ___________________________
LOCATION: ______________________________________________ HOURS ________________________
(
Include Suite, Apartment, Bay and/or Building Number)
CITY: _______________________________ STATE: ______________
ZIP: _______________________
BUSINESS PHONE: ________________________ BUSINESS TYPE: ______________________________
EMERGENCY CONTACTS
1. __________________________________________________ ______________________________________________
Name
Title
___________________________________________________ ____________________________________________
Home Address
Home Phone
___________________________
____________________________
___________________________________
Mobile Phone
Pager
Work Phone
2. __________________________________________________ ______________________________________________
Name
Title
_________________________________________________ ______________________________________________
Home Address
Home Phone
___________________________
____________________________
___________________________________
Mobile Phone
Pager
Work Phone
3. __________________________________________________ ______________________________________________
Name
Title
_________________________________________________ ______________________________________________
Home Address
Home Phone
___________________________
____________________________
___________________________________
Mobile Phone
Pager
Work Phone
PREMISE INFORMATION
SECURITY DOG ___YES ___NO
HAZARDOUS MATERIAL ____YES ___NO
TYPE ______________
LIGHTS ON AT NIGHT ____YES ____NO LOCATION _______________________________________________
ALARM ___YES ____NO ALARM CO. NAME ________________________ PHONE _____________________
PLEASE RETURN THIS FORM WITH YOUR BUSINESS TAX RECEIPT APPLICATION

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