Business Name

Business Address

Business Phone(s)

Type of Business

Keyholder – someone available to come out 24 hrs a day with a key

1.  Name  

     Phone   Alt phone

    E-Mail

2..  Name  

     Phone   Alt phone

    E-Mail

Alarm Company Name

Phone Number

City Alarm Permit Number

Knox Box – keeps a key on site for the fire department to use for entry

Knox Box Location

(For more information on Knox Box, call the Asst Fire Marshal 281-337-6262)

Hazardous Chemicals stored on premise (use back of page if needed)

Name

ID #   Guide #

Storage Location

Name

ID #   Guide #

Storage Location

Name

ID #   Guide #

Storage Location

Name

ID #   Guide #

Storage Location

Name

ID #   Guide #

Storage Location

Any additional info, special instructions or special needs for your business

Note: Please notify the Dickinson Police Department about any changes to registration information and/or chemicals on site.

Phone: 281-337-4700, Mail: 4000 Liggio Dickinson, Tx. 77539, or on line at www. ci.Dickinson.tx.us