Request House Check

2. House Check Information / Requirements
   The maximum time frame for a watch or check is one month or 30 days. If you will be gone longer, it is your obligation to provide the police department with an updated form.
   
   If you will not be away from your home, explain in additional information box below why you are requesting a house check.
   
   Please provide us one weeks notice prior to your departure for you vacation / leave.
4. Name*
5. Email Address
7. Address*
9. City*
10. State*
11. Zip Code*
13. Primary Phone Number*
14. Cell Phone Number
15. Another Number we can reach you at while you're gone:
17. Departure Date*
    Departure Date
18. Return Date*
    Return Date
    No longer than 30 days from Departure Date
22. Does your home have an alarm system?

    1. Yes

    1. No
23. If "Yes" Alarm Company Name
24. Alarm Company Phone Number
28. Will someone be checking the home while you are away?

    1. Yes

    1. No
30. Name: Emergency Contact Number 1 (EC1)
31. Name: Emergency Contact Number 2 (EC2)
33. EC1 Primary Phone Number
34. EC2 Primary Phone Number
36. EC1 Cell Phone Number
37. EC2 Cell Phone Number
39. EC 1Relationship

    1. Relative

    1. Neighbor

    1. Friend
40. EC2 Relationship

    1. Relative

    1. Neighbor

    1. Friend
42. Does EC1 have a Key?

    1. Yes

    1. No
43. Does EC2 have a key?

    1. Yes

    1. No
47. Lights on in home?

    1. Yes

    1. No
49. Location of lights:

    1. Bedrooms
    2. Bathrooms

    1. Kitchen
    2. Living Room

    1. Other Locations

    Describe other locations in following field.
50. Describe other locations where lights are on:
54. List the vehicles in the garage:
    Color, make, model, license plate, etc.
55. Vehicles in the driveway
    Color, make, model, license plate, etc.
59. Any additional information that we may need:
Leave This Blank:


61. 1. Receive an email copy of this form.
62. Email address

    This field is not part of the form submission.

63. Submit

* indicates a required field