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City of Washington, NC

Application for Business Privilege License
Washington Police Emergency Contact Information Form

 
Any information gathered on this form is confidential and will only be used for official purposes by the Washington Police Department.
 
Instructions: Please fill out this form completely. Please PRINT very clearly and neatly in ink.
 
DATE: BUSINESS NAME:
ADDRESS OF BUSINESS:
MAIN PHONE NUMBER OF THE BUSINESS:
_________________________________________
INCLUDE AREA CODE
 

EMERGENCY CONTACT INFORMATION**
This is a list of people that the POLICE can call in case of an emergency.

1. NAME:
PHONE #: __________________________
INCLUDE AREA CODE
ADDRESS: __________________________________________________________________________
                                          STREET ADDRESSES ONLY - NO P.O. BOXES
2. NAME:
PHONE #: __________________________
INCLUDE AREA CODE
ADDRESS: __________________________________________________________________________
                                          STREET ADDRESSES ONLY - NO P.O. BOXES
2. NAME:
PHONE #: __________________________
INCLUDE AREA CODE
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.
 

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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