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 *

1 Business Name: *
2 Brookfield Business Address: *

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