Form Center

2. Dear Resident: This security check service in no way guarantees that your property will be safe from vandalism or burglary, but merely provides the Berryville Police Department with information of your whereabouts and other pertinent facts if a crime should occur.
4. I request a SECURITY CHECK be made of my premises and agree to notify the Police department of my return.
6. Signature*
   Electronic Acknowledgment
7. Date*
   Date
9. First Name*
10. Last Name*
12. Address*
14. Phone Number*
15. Departure Date*
16. Return Date*
18. Security System*
    -- Select One --YesNo
19. Automatic Light*
    -- Select One --YesNo
20. If yes, Location(s)*
22. Vehicles Left*
    -- Select One --YesNo
23. If yes, Tag(s)*
27. Have keys been left with anyone?*
    -- Select One --YesNo
29. If yes, Name:*
30. Phone Number*
32. Address*
34. City*
35. State*
36. Zip*
40. Will anyone be staying or otherwise have access to your residence during your absence?
42. If yes, Names:*
46. Who do you want us to notify in an emergency?
48. Name*
49. Phone Number*
51. Address*
53. City*
54. State*
55. Zip*
Leave This Blank:


57. 1. Receive an email copy of this form.
58. Email address

    This field is not part of the form submission.

59. Submit

* indicates a required field