Wireless Provider Contact Information

Please include the required information in the attached form. If you are updating your contact information, please check the "This is an update" box prior to submitting. Fields marked with * are required. Information submitted will be shared with the Kentucky State Police. COMPLETION OF THIS FORM SATISFIES THE REQUIRED SUBMISSION OF EMERGENCY CONTACT INFORMATION TO THE KENTUCKY STATE POLICE AND THE KENTUCKY 911 SERVICES BOARD.

Are you a reseller?*

Example: Press 4 at the prompt

Please include the name and title of the individual responsible for maintaining contact information for exigent circumstance requests.

Please include the email address for the Point of Contact. This may be a shared inbox.

If this is an update to information we have on file, please check this box so the record may be edited. If this is a new submission or if you're unsure, leave the box unchecked.

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