Police – Business Owners Emergency Contact Information

PIERCETON POLICE DEPARTMENT
207 N. FIRST STREET
PIERCETON, IN 46562
574.594.2232

Greetings Pierceton Business Owners:

This form is to obtain emergency information about the businesses that you’re operating within the town limits of Pierceton, Indiana. To better serve you and help our officers during patrol, we invite you to complete the information below.

Your information will be used by the Pierceton Police Department and the Kosciusko County Dispatch Center to contact you and your key holders in case of an emergency at your business after hours.

This form is voluntary, and not mandatory. If you choose to participate, please complete the form and return it to the Pierceton Police Department or Email at the address above.

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Business Name: *

Business Contact Name: *

Business Physical Address: *

Business must be in Pierceton Indiana

Business Phone: *

Email

Key Holder #1 *

Key holders will be called in order.

Key Holder #1 Phone *

Key Holder #2

Key Holder #2 Phone

Key Holder #3

Key Holder #3 Phone

Comment or Message

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