Emergency Contact Form For Businesses

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Help The Police Protect Your Business

The Leesburg Police Department recommends providing the department with emergency contact information for your business this information can be used by officers to make timely contact with a representative for an emergency such as:

  •  After hour alarm problems.
  •  Timely notification of an incident involving your business.
  •  Provides police department business's point of contact in the event of an emergency. 

With an up to date business emergency notification form, the Leesburg Police Department can better serve the business owners of Leesburg.  Businesses that are situated within the town limits of Leesburg are eligible to file their contact information with the department.   The LPD business emergency contact form can be completed using the form below.   All business emergency contact forms should be completed and submitted online. 

If you have any questions about this form please contact Public Information Officer Sam Shenouda at 703-771-4538.

Please correct the field(s) marked in red below:

Business Contact Information
 *
Business Contact Information
Primary Emergency Contact/Key Holder:
 *
Primary Emergency Contact/Key Holder:
Alternate Emergency Contact/Key Holder:
 *
Alternate Emergency Contact/Key Holder:
Second Alternate Emergency Contact/Key Holder:
Second Alternate Emergency Contact/Key Holder:
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