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2. West Norriton Township Fire Marshal/Emergency Management

   All information provided below is considered confidential and will be utilized by West Norriton Township officials in the event of an emergency involving your business/facility. Please contact the Fire Marshal (MValyo@wntwp.com) with any questions or changes. 

4. Emergency Contact Information
6. Business Name
8. Address1
10. Address2
12. City
13. State
14. Zip
16. Website
17. Email
19. Name of Alarm Company
20. Phone Number
22. Primary Business Contact and 24-Hour Emergency Contact
24. First Name
25. Last Name
27. Address1
29. Address2
31. City
32. State
33. Zip
35. Cell Number
36. Home Number
38. Email Address
40. Secondary 24-Hour Emergency Contact
42. First Name
43. Last Name
45. Address1
47. Address2
49. City
50. State
51. Zip
53. Cell Number
54. Home Number
56. Email Address
58. Today's Date
    Today's Date

    Today's Date
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60. 1. Receive an email copy of this form.
61. Email address

    This field is not part of the form submission.

62. Submit

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