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2. INSTRUCTIONS:
   If you consent for the Bristol police to have access to your video for investigative purposes, complete this form and send to the police department using the submit button displayed below. Your information about video/camera equipment will not be shared with the public. Thank-you for your partnership.
4. Camera is located at the following address: *
5. Does the camera face the roadway? *
   -- Select One --YesNoPartial

   Pick one
7. Contact person(s):*
9. Best phone(s) for contact:*
11. Email address:*
15. Location type:*

    1. Residence
    2. Buisness
    3. Other

    Pick one
16. Number of camera(s) facing road?*
17. Is surveillance system monitored by a security company?*

    1. Yes
    2. No

    Pick one
19. Recording period?
20. Image retention period?*
22. Do you want a sticker advertising our partnership?*

    1. Yes
    2. No
24. Comments:
Leave This Blank:


26. 1. Receive an email copy of this form.
27. Email address

    This field is not part of the form submission.

28. Submit

* indicates a required field