New Business Registration
Local Business Information:
Business Name
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
EIN
*
Business Owner Information:
Business Owner
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Building Owner Information:
Building Owners Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Agent / Property Manager (if applicable):
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
*Where would you prefer notices and invoices be sent? (Check One):
*
Local Business
Business Owner
Property Manager / Agent
Emergency Contacts:
(i.e. who we can contact after hours in the event of an emergency)
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
About Your Business:
Please describe your business / use (i.e., storage of medical supplies or computer design firm)
*
Primary square feet occupied
*
Secondary Use if applicable (i.e., Primary use would be 8,000 sq ft warehouse, secondary use would be 1200 sq ft of office space)
*
Type "N.A." If none.
Secondary square feet occupied
*
Enter "0" if none
BOCA Use Group:
*
Occupancy Load:
*
Block: & Lot:
*
Insurance Carrier Name:
*
Insurance Carrier Policy Number:
*
About Your Building:
No. of Stories:
*
Please Select
1 Story
2 Story
3 Story
Construction Type:
*
Please Select
Fire-resistive Type I (IA and IB)
Non-combustible Type II (IIA and IIB)
Ordinary Type III
Heavy Timber Type IV
Wood-Framed Type V
Unknown
Truss:
*
Please Select
Yes
No
Basement:
*
Please Select
Yes
No
Attic:
*
Please Select
Yes
No
Heating System:
*
Please Select
Gas
Electric
Oil
Other
Egress Lighting:
*
Please Select
Yes
No
Electrical System
*
Please Select
Basement
1st Floor
2nd Floor
3rd Floor
Other
Number of Exits:
*
Fire Detection / Suppression:
Smoke Detectors –
*
Please Select
Yes Smoke Detectors (Not Monitored)
Yes Smoke Detectors (Monitored)
No Smoke Detectors
Fire Suppression System: - / - Fire Pump:
*
Please Select
Yes - fire suppression system
Yes - fire suppression system & fire pump
No - fire suppression system
Limited area fire suppression system
Fire Department Key Box (Knox Box):
*
Please Select
Yes
No
Location Of Key Box (Knox Box)
*
Type N.A. If none.
Fire Alarm Monitoring Company Name:
*
Type N.A. If none.
Fire Alarm Monitoring Company Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Fire Alarm Monitoring Company Phone Number
Submit
Should be Empty: