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Brazoria Police Department Citizen Request for Security Check

  1. **Property Owners, Renters, or Leasers of property may request a Security Check for property. Patrols will not last for over 10 days unless approved by Chief of Police**

  2. STRUCTURE TO BE CHECKED*

  3. WILL ANYONE HAVE ACCESS TO PREMISES*

  4. WILL ANY LIGHTS BE LEFT ON PREMISES*

  5. WILL ANY VEHICLES BE PARKED ON PREMISES*

  6. INCASE OF EMERGENCY DO YOU WISH TO BE CONTACTACTED*

  7. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

  8. Leave This Blank:

  9. This field is not part of the form submission.