City of Rockford

Fill this form out to submit and/or update contact information for Police and Fire emergencies.

Business Name*

Business Address*

Street Address Address Line 2 City State ZIP Code

Business Phone*

Emergency Contact Name #1*

First Last

Contact Home Phone #1

Contact Cell Phone #1

Emergency Contact Name #2*

First Last

Contact Home Phone #2

Contact Cell Phone #2

Emergency Contact Name #2*

First Last

Contact Home Phone #3

Contact Cell Phone #3

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Business Contact Information