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Survey of Tenants/Owners of Commercial Properties

Please provide the following information about your specific commercial operation in the Town of Brookfield. [Full Instructions ...]

Please complete the entire survey. Some responses may be N/A or Unknown. If you do not know the size of the leased space, your landlord might be able to provide that information.

Denotes Required Field *

1Business Name: *
2Brookfield Business Address: *

Brookfield, CT 06804
3WPCA Account Number:
4Primary Contact Name: *
5Primary Contact Phone:
6Primary Contact Email: *
7Primary Contact Mailing Address (if different from the business address):
8Alternate Contact Name:
9Alternate Contact Phone:
10Alternate Contact Email:
11Size of Leased Premise: *
Numbers only
12Type of Use (Restaurant, Office Space, Retail, Fitness, Salon, etc):
13Description of the use. (Please be specific. See Instructions):

 Question 13 (Description of Use): Please be specific when completing this question. Some examples of how you might fill out this question are as follows these are examples only. The more specific you are the more beneficial it is to the BWPCA.  

 “The use is a sit-down restaurant with XX seats in the dining room and xx seats at the bar. We provide take out service”

 “The use is an office space with xx employees.”

 “The use is a hair salon or barber shop and we have xx chairs”

 "The use is a retail space and we typically have xx number of employees in the space”