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Convenience Store Registration

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Thank you for registering your convenience store with the Hurst Police Department. Before completing and submitting the form below, please watch this convenience store safety video produced by the Houston Police Department.

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

HURST POLICE DEPARTMENT

Convenience Store Registration Form

As required by City of Hurst ordinance number 2458, convenience stores are now required to register with the Hurst Police Department. All form questions are REQUIRED to be completed with the exception of a fax number.

Thank you for your submission.

Hurst Police Department


Store Name:
 *
Store Address
 *
Store Phone
 *
Store Fax
 *
City
 *
State
 *
Zip Code
 *
First Name
 *
Last Name
 *
Address
 *
City
 *
State
 *
Zip Code
 *
Phone Number
 *

Email

Email will be used to send registration information and updates

 *

or

STORE OWNER (CORPORATION)

Enter NONE or N/A in required fields if your store is not corporately owner

Corp Contact First Name
 *
Corporate Contact Last Name
 *
Corporate Name
 *
Corporate Contact Address
 *
Corporate Contact City
 *
Corporate Contact State
 *
Corporate Contact Zip Code
 *
Corporate Contact Phone
 *

Email

E-mail will be used to send registration information and updates

 *
MANAGER / STORE OPERATOR INFORMATION
First Name
 *
Last Name
 *
Address
 *
City
 *
State
 *
Zip Code
 *
Manager Phone
 *
24 Hour Contact Number
 *

Email

Email will be used to send registration information and updates

 *
I UNDERSTAND THAT THIS APPLICATION IS AN OFFICIAL GOVERNMENT RECORD. I UNDERSTAND THAT KNOWINGLY MAKING A FALSE ENTRY OR OMITTING REQUIRED INFORMATION IN ONE OR MORE OF THE ABOVE FIELDS COULD RESULT IN CRIMINAL CHARGES AND TEH DENIAL/REVOCATION OF MY REGISTRATION.
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