Thank you for partnering with the Keller Police Department in keeping our community safe! Information provided to the Keller Police Department regarding your camera systems will be for official use only. Your personal information will remain confidential and will not be distributed except as required by law or court order.

1

Today's Date

 *

Today's Date

2

First Name

 *

First Name

3

Last Name

 *

Last Name

4

Business Name (If Applicable)

Business Name (If Applicable)

5

Additional Residents' Names (Please provide the names of any resident over the age of 18 residing at the location.)

Additional Residents' Names (Please provide the names of any resident over the age of 18 residing at the location.)

6

Address

 *

Address

7

Zip Code

 *

Zip Code

8

Phone Number

 *

Phone Numberext.

9

E-mail Address

 *

E-mail Address

10

Number of Cameras at Property

Number of Cameras at Property(Select an Answer) 1 2 3 4 5 6 or More

11

Camera Views

 *

Camera Views

Front Yard

Back Yard

Driveway

Alley

Front Door

Back Door

East Side of Property

West Side of Property

North Side of Property

South Side of Property

Patio

Other

12

Any Additional Information for KPD?

Any Additional Information for KPD?

1. To receive a copy of your submission, please fill out your email address below and submit.
2. Email Address

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