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Security Check Form

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First Name*
Last Name*
Address*
City*
State*
Zip Code*
Phone Number*
Fax Number
Email Address*
Departure Date*
Departure Date
Return Date*
Return Date
Property Type*
Alarm Company Name
Alarm Company Phone Number
Type of Alarm Sensors
Lights Left On Timers
Lights Left On Constantly
Animals Left On Premise
Vehicles Left At Premise
Will anyone be working at or have access to the premises during your absence? (Proved Names if Applicable)*
If keys have been left with anyone please provide their information below.
Name
Phone Number
Provide up to three emergency contacts.
Name*
Email Address
Address
City
State
Zip Code
Phone Number*
Fax Number
Name
Email Address
Address
City
State
Zip Code
Phone Number
Fax Number
Name
Email Address
Address
City
State
Zip Code
Phone Number
Fax Number
What password would you like to use to terminate your security check?*
Drivers License Number (Used to confirm address information.)
By typing in my first and last name on the lines below I am requesting a security check of my property while I am out of town and agree to notify the Effingham County Sheriff's Office upon my return with the appropriate password.
First Name*
Last Name*
Date*
Date