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3. 
6. Emergency Contact Information Update Form
   Accurate contact information for your business is critical to ensure that the Palatine Fire Department knows who to contact in the event of an emergency. The Palatine Fire Prevention Division also relies upon reliable contact information when conducting routine fire inspections, special events, and addressing concerns related to the fire code adopted by the Village of Palatine. The information provided below will be utilized to update our records and by our dispatch center should an emergency occur at your business. Should contacts change, please feel free to update this contact information or contact our office at 847-359-9029.
8. Business Name*
9. Business Address*
11. Business Phone
12. Business E-Mail
16. Who should we contact, and in what order?
    Please enter the full name, phone number, and e-mail address of those we should contact in the event of an emergency at your business.
18. Priority
    -- Select One --123
19. Name
20. Phone
23. Title
26. E-Mail
28. Priority
    -- Select One --123
29. Name
30. Phone
33. Title
36. E-Mail
38. Priority
    -- Select One --123
39. Name
40. Phone
43. Title
46. E-Mail
Leave This Blank:


48. 1. Receive an email copy of this form.
49. Email address

    This field is not part of the form submission.

50. Submit

* indicates a required field