Complete the following information and the police department will drive by your property while you are on vacation.

Contact Information

Name:*

Address:*

City:

State:

Zip:

Phone Number:*

Email Address:

Vacation Information

Date Leaving:*

Date Returning:*

Do you have any lights on?*

Yes

No

Are lights on a timer?

Yes

No

Location of Lights:

Security / Alarm System?*

Yes

No

Alarm Company Name:

Any Vehicles in Driveway?*

Yes

No

Vehicle Description (Year, Make, Color):

Vehicle Description (Year, Make, Color):

Vehicle Description (Year, Make, Color):

Emergency Contact Information

Name:*

Address:*

Phone Number:*

Does Emergency Contact Have Key?*

Yes

No

Emergency Contact's Vehicle Description (Year, Make, Color):

Miscellaneous Information