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2. Brevard Police Department Security Check Request Form
4. Type of Check*
   -- Select One --Vacation House CheckExtra Security Check
5. Requested Start & End Dates*
   Requested Start & End Dates Start Date

   —

   Requested Start & End Dates End Date
   For vacation house checks please check the date you are leaving and the date that you will return. All other checks are typically for a maximum of two (2) weeks unless there is a reason otherwise.
7. Requester Name*
8. Requester Phone Number*
10. Business Name
11. Contact Person and Phone
13. Address of Check Location*
    This is your full street address to include an apartment number if applicable.
15. Address 2
16. City
18. Reason for Extra Security Request*
    Please give a description as to why you are requesting an extra security check of your home or business. This can help our Officers when they are patrolling the area to know what to look out for.
20. The following fields are specific to if you are requesting a vacation house check
22. Description of Vehicles Left On Site
23. Description of Any Lights Left On
25. Should anyone be on or around the property?

    1. Yes

    1. No
26. If so, who?
Leave This Blank:


28. 1. Receive an email copy of this form.
29. Email address

    This field is not part of the form submission.

30. Submit

* indicates a required field