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Request for Vacation Check, Business Check, or Area Check

2. Choose Type of Request*
   -- Select One --Vacation CheckBusiness CheckArea Check

3. Business Name*

5. Requested Area to be Checked:*

7. Name of Person Requesting Check:*

8. Email Address*

10. Address*

12. Phone Number*

13. Dates*
    Dates Start Date

    Dates Start Time

    —

    Dates End Date

    Dates End Time

15. Reason for Requested Check:*

17. How can we contact you in an emergency?

    1. Phone
    2. Text
    3. Email

18. Key left locally with:

20. Will anyone be on the premises?

    1. Yes
    2. No

21. If so, Name and Phone Number:*

23. Any vehicles on the premises?

    1. Yes
    2. No

24. If so, please describe:*

26. Any lights left on?

    1. Yes
    2. No

27. If so, where:*

29. Do you have an alarm system?

    1. Yes
    2. No

30. If so, who or what alarm company can be notified in case alarm is activated?*

32. Are there any animals on premises?

    1. Yes
    2. No

33. If so, please describe animal(s):*

35. Paper or mail stopped?

    1. Yes
    2. No

36. Do you wish to be contacted by text message after a check has occured? (Please keep in mind this could be late at night)

    1. Yes
    2. No

37. Cell Phone Provider*
    -- Select One --SprintVerizonAT&TT-MobileMetro PCSBoostVirginCricketUS CellularOther

    If not listed, provide carrier in additional information field. Message and data rates may apply.

39. Is there any additional information you would like us to know?

    By completing this form, you grant the Lake Saint Louis Police Department permission to enter upon your premises for the purpose of checking for criminal activity, theft, property damage, or signs of a break in.

Leave This Blank:


41. 1. Receive an email copy of this form.
42. Email address

    This field is not part of the form submission.

43. Submit

* indicates a required field