ECC Business Contact Information Form

After Hours Emergency Contact Info

If this is an emergency, dial 9-1-1

If you are unable to call 9-1-1, you can text to 911. Provide as much information as possible.

If this is a non-emergency, call 785-843-0250

Business Contact for after hours, weekends, and holidays. Contact numbers will only be used when there is an emergency at the business after hours and a responder is needed.

If you need a printable PDF, please download the form here.

Full Name

Name of person filling out form

Confirmation Email

Email address of person filling out this form

Business

Name

Phone

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Business Owner

Primary Owner Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Driver's License Number

Driver's License State

Business Contacts

How many contacts will you be providing?

First Contact

Name

Driver's License Number

Driver's License State

Primary Phone

Will try to call this number first

Secondary Phone

Second Contact

Name

Driver's License Number

Driver's License State

Primary Telephone

Will try to call this number first

Secondary Phone

Third Contact

Name

Driver's License Number

Driver's License State

Primary Phone

Will try to call this number first

Secondary Phone

Security

Do you use a security company?

Alarm Company Name

Company Phone

Is there a lock box or key box?

Location of Box