🔐Knox Box Registration and Installation Request Form🔐

🔐Knox Box Registration and Installation Request Form🔐
Benton County Fire District #4 maintains information about Knox Boxes located at residences and businesses within the District.

Please use this form to register an existing Knox Box or to request information/assistance with installing a new Knox Box.
Today's Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
What would you like to do?
Contact Information
Name

First NameLast Name
Business/Organization Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Property Type

Other
Property/Knox Box Location
Address where Knox box is located or will be installed

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Property/Business Name
Existing Knox Box Information
Is the Knox Box currently installed
Where is the Knox Box located on the building/property?
Example: To the right of the main entrance, approximately 5 feet above ground.
Approximately when was it installed?
Month/Year or "Unknown"
What type of keys or access items are currently stored in the Knox Box?

Other
Upload a photo of the installed Knox Box

Optional, but very helpful in locating and documenting the box.
Cancelof
Has Benton County Fire District #4 previously accessed or verified this Knox Box?
New Knox Box Request
Have you already purchased a Knox Box?
Has it already been installed?
Knox Boxes must be compatible with the Benton County Fire District #4 Knox system. District staff will contact you regarding the appropriate Knox Box and installation location before installation.
Where are you considering installing the Knox Box?
Is there a gate or other controlled access to the property?
Please describe the gate/access system
Additional Information
Is there anything else we should know about the property or Knox Box?
I understand that submitting this form does not constitute approval of a Knox Box location and that Benton County Fire District #4 may contact me regarding installation, access, or verification.
Signature
Should be Empty:

🔐Knox Box Registration and Installation Request Form🔐

Contact Information

Property/Knox Box Location

Existing Knox Box Information

New Knox Box Request

Additional Information