Clear Creek County Sheriff's Office

*Business Name:

*Physical Address:

*Mailing Address:

*Business Phones:

*Fax:

*Days and Hours of Operation:

*Owner/Manager Name
and Phone:

After hours contacts:

Name and Position

Phone numbers

Alarm company name and phone number:

Type of alarm (fire/medical, panic, motion, audible/silent):

Will alarm notify the alarm company?

*Type of Business:

Any special needs or safety concerns (animals, guns, chemicals, fire hazards:

*Completed by:

*E-mail Address
(A copy of the submitted form will be sent to this address.):

*Confirm E-mail Address:

*Date:

*Business #:
(Assigned by Sheriff’s Office)

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Sheriff's Office