Plainfield SID Security Camera Program Registration


Name:_______________________________________________________________________________________________________

Company/Business Name: ____________________________________________________________________________________________________________
Address: ____________________________________________________________________________________________________________

City: ________________________________________________

State: ______________ Zip: __________________

Telephone #: ________________________________________

Fax #: ______________________________________________

Email:______________________________________________________________________________________________________

Questionnaire:

1.Do you have security surveillance at your location? If yes, what kind? ____________________________________________________________________________________________________________

If yes, skip to question 3.

2. If no, why are you requesting security surveillance at this time? ____________________________________________________________________________________________________________


3. Have you ever had a burglary at your location/place of business? ____________________________________________________________________________________________________________

4. Who will monitor these cameras and who will be responsible for access to any recording,
should the police feel that your equipment/recordings may help in a crime investigation?

____________________________________________________________________________________________________________
5. Some equipment requires a broadband network; you are required to pay additional
charges on a monthly basis that are not reimbursed through this program.

Do you understand?_______


Kindly submit your replies to Plainfield SID, c/o Netherwood Auto Repair, 1000 South Avenue,
Plainfield, NJ 07062