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2. Business Information
3. Date Completed:
5. Business Name:
7. Address:
9. Phone Number:
10. Email:
12. Owner:
14. Address:
15. City:
17. Phone Number:
18. Email:
20. Does the business have security cameras?

    1. No

    1. Yes

    1. Interior

    1. Exterior
22. After Hours Contacts
24. Primary:
25. Name:
27. Address:
28. City:
30. Phone Number:
31. Email:
33. Secondary:
34. Name:
36. Address:
37. City:
39. Phone Number:
40. Email:
42. Alternate:
43. Name:
45. Address:
46. City:
48. Phone Number:
49. Email:
51. Details

    If the contacts for your business change please notify the El Dorado Police Department so your business contact file can be updated. This can be done by contacting the Police Department at (316)321-9120 Mon - Friday 8am - 5 pm. or by emailing an updated Business Contact Sheet to eldoradopolice@eldoks.com.

Leave This Blank:


53. 1. Receive an email copy of this form.
54. Email address

    This field is not part of the form submission.

55. Submit

* indicates a required field