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2. This information is provided to the Waterville Fire Department to be used in an emergency to make contact with the responsible party for the location. If you are a new business, please include the former name of the business, if applicable. When adding emergency contacts please use people who are local and have access to the building.
4. Current Business Name*
5. Former Business Name
6. Phone Number
8. Business Address
10. Address Line 2
11. City
12. State
16. Emergency Contacts

    Please list Emergency Contacts in the order that they should be called. Please keep in mind that we are looking for the closest person that has access to the building.

18. Emergency Contact 1
19. Phone Number 1
21. Emergency Contact 2
22. Phone Number 2
24. Emergency Contact 3
25. Phone Number 3
29. Business Owner Name
30. Business Owner Email
32. Business Owner Address
34. Address Line 2
36. City
37. State
38. ZIP Code
42. Building Owner Name
43. Business Owner Email
45. Building Owner Address
47. Address Line 2
49. City
50. State
51. Zip Code
55. Name of the Person Submitting the Form
56. Email of the Person Completing this Form *
Leave This Blank:


58. 1. Receive an email copy of this form.
59. Email address

    This field is not part of the form submission.

60. Submit

* indicates a required field