Village of Rye Brook - Reverse 911®

Reverse 911® Change Form

Please fill in the following information regarding whether you wish to ADD, CHANGE or DELETE your information from the Reverse 911® Database. The information will not be sold or given to anyone outside the Village of Rye Brook. Reverse 911® is only used for High Priority Community Notifications or Public Safety Emergencies.

What is Reverse 911®?

The Reverse 911® Community Notification System is built to pull up a selected grouping of phone numbers, call the number and play a pre-recorded message giving emergency instructions to whoever receives the message. The system uses software to call selected phone numbers. The local phone company supplied the phone numbers to create the database and the database is updated every week. What phone numbers are not in the database? Broadband phone carrier numbers (ex. Cablevision) and cell phone carrier numbers (ex. Verizon Wireless) are not in the database. Please use this form to add or maintain your phone numbers. Additionally, if a person or business does not wish to be notified in an emergency they can request that their phone number be removed from the database.

	Are you Adding, Changing or Deleting your number from the database?
Action:	Please select one. If you are unsure select Adding.
	Please enter area code and seven digit number. Two commas must separate the 10-digit phone number and the extension number. Ex: 9149391234,,5678
Phone:	*required
	If residential, enter Last and First Name and Middle Initial. Ex: Public John Q
Name on the phone account:	*required
Street Number:	*required
Street Name:	*required
Address 2:
City:
State:	NY
Zip:
Zip+4:
You are a:	Residence Business
	Please enter area code and seven digit number.
Fax:
	Please enter area code and seven digit number.
TTY:
You are:	Listed Unlisted
	If you do not have an email address please enter 'na'.
E-mail:	*required