Forms • Cocoa • CivicEngage

Emergency Business Contact Form

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**ALL INFORMATION IS STRICTLY CONFIDENTIAL AND EXEMPT FROM PUBLIC DISCLOSURE**

Dear Merchant:
The Cocoa Police Department requests your assistance to help serve you. If your business has been disturbed during the evening or early morning hours, if there has been an alarm or fire, or if we find an open door or anything unusual, it is necessary for our responding officers to be able to contact a responsible person to respond to the area immediately. Your assistance in fully answering the following questions is appreciated. Once you submit the form, the information will be sent directly to our records division personnel. Thank you.

Name of Business:

Business Address:

Business Phone:

Security System Installed

Yes

Security System Type (Audible, Motion, Etc., if applicable)

Describe Security System Details:

Security Company Name and Phone Number:

Cameras on Property:

Yes

Flammable/Combustible Materials inside or near business:

Yes

Location and Type of Materials:

If your business has a security gate, Cocoa Police Department would like the code or combination to allow access to the property in the event of an emergency and/or to conduct business checks.

Automatic Security Gate:

Yes

Gate Code:

Emergency Contacts: **MUST HAVE BUSINESS KEYS AND BE WITHIN 15-20 MINUTES ARRIVAL TIME**

Name and phone number:

Please notify us of any additions or deletions of above listed persons who will be responding to any emergency incidents. If you permanently close or sell your business, please change the information with us, or have the new owner(s) update the information for our records.

Permanent Email Address:

Form #CPD 31 (06/2019)

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