Recorder Logo  Emergency Communications Emergency Contact Form

401 East Main Street
Richmond IN 47374
Located in the Wayne County Administration Building

Director: Matthew Cain
Phone EMERGENCY ONLY: 9-1-1
Phone Non-Emergency: (765) 973-9355
FAX: (765) 973-9468
E-Mail: dispatch@co.wayne.in.us


Richmond/Wayne County 911 Emergency Contact Form

The following form is to assist the Richmond Public Services (fire, police and communications) to better serve the Richmond/Wayne County business community in case of emergencies.

Please fill in the form completely. Once completed, make sure all information is correct, then hit "Submit" at bottom of the form. This is confidential information and will be used for emergency purposes only. If there are changes at any time to your information, you can submit a new form, or notify one of the two departments listed below as soon as possible. Your information is immediately sent to the Richmond/Wayne County 911.

If you have any questions regarding this request, you can contact Matthew Cain, Deputy Director Wayne County 911 at 765-973-9355

Please help us serve you better.


Business Name:
Business Street Address:
Address (cont.):
City:
State:
Zip Code:
Business Phone:
Business Fax Number:
Business E-mail Address:
Primary Contact Name:
Title:
E-Mail address:
Home Phone:
Cellular Phone:
Pager:
Alternate Contact Name:
Title:
Home Phone:
Cellular Phone:
Pager:
Insurance Company:
Agent:
Phone:
Building Owner:
Phone:
Property Manager:
Phone:
Alarm Company:
Phone:
City Alarm Permit Number: