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2. Contact Information
4. First Name*
5. Last Name*
7. Business Name
8. Address*
10. City*
11. State*
12. Zip Code*
14. Primary Phone Number*
15. Secondary Phone Number
16. Email Address*
18. Security Camera Information
20. Address of camera(s)*
21. Number of Cameras*
    -- Select One --1234567+
23. Areas Covered (Check all that apply)*

    1. Front
    2. Back
    3. Parking Lot
    4. Alley

    1. Building Entry
    2. Building Exit
    3. Street in Front

    1. Street in Back
    2. Street on Side(s)
    3. Other
25. If you checked Other, please describe below:
27. Recording Type*
    -- Select One --ContinuousMotion-activatedOther
28. Other camera details, information
30. Relevant documents/images
32. Privacy & Permissions
34. Preferred Contact Method
    -- Select One --Primary PhoneSecondary PhoneEmail
36. Acknowledgement*

    1. I understand this program is voluntary. The Klamath Falls Police Department will not have direct access to my cameras, and I may choose whether or not to share footage if contacted.
Leave This Blank:


38. 1. Receive an email copy of this form.
39. Email address

    This field is not part of the form submission.

40. Submit

* indicates a required field