2. 

4. This form can be used by businesses that are located within the Town or Village of Webster, NY to notify or update the Webster Police Department who they would like to be contacted in the event of an incident after hours, as well as, the critical details of the location. 

   All information submitted will be verified before being considered valid. 

   If you have any questions about this form please contact Sgt. Engel (585) 872-1216 x 3344.

6. Today's Date:
8. Business Name (and Store Number if applicable):
10. Type of Business:
12. Business Address:
14. Business Phone Number:
16. Business Email Address:
18. Your Name and Title:
24. Security:
    Please respond to the questions below.
26. Security Monitor Service Used? If so, which company?
28. Camera Location: None / Interior only / Exterior only / Both
30. If so, live feed only / recorded only / both
32. If so, can footage be reviewed immediately? On scene?
38. Please describe any regular overnight activity: (Cleaners, deliveries)
40. Please use the box below to provide any additional information regarding Location:
46. Business Contact Information:
50. Contact Person 1:
52. Name:
54. Position:
56. After Hours Phone Number:
58. After Hours Address:
60. Access to Cameras Described Above? (if applicable) Yes/No
62. Able to Arrive on Scene if Needed? Yes/No
64. Additional information regarding Contact Person 1:
68. Contact Person 2:
70. Name:
72. Position:
74. After Hours Phone Number:
76. After Hours Address:
78. Access to Cameras Described Above? (if applicable) Yes/No
80. Able to Arrive on Scene if Needed? Yes/No
82. Additional information regarding Contact Person 2:
86. Contact Person 3:
88. Name:
90. Position:
92. After Hours Phone Number:
94. After Hours Address:
96. Access to Cameras Described Above? (if applicable) Yes/No
98. Able to Arrive on Scene if Needed? Yes/No
100. Additional information regarding Contact Person 3:

102. Thank you for filling out the registry form!

     Please select the SUBMIT button below to complete this process.

Leave This Blank:


104. 1. Receive an email copy of this form.
105. Email address

     This field is not part of the form submission.

106. Submit Submit and Print

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