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2. Individual / Business Name:*
3. Registration Type:*
   -- Select One --IndividualBusiness

   Please select Individual or Business from the drop down menu.
5. Street address of camera location:*
   Please enter the street address where the camera(s) is/are located.
6. Apt/Unit #
8. Contact E-mail Address:*
9. Contact Phone Number:*
11. Video System Components*

    1. Interior Views
    2. Exterior Views
12. Check off exterior coverage areas

    1. Front Yard
    2. Back Yard
    3. Left side of house
    4. Right side of house
    5. Driveway
    6. Street view
14. Please describe nearby landmarks or intersections that are recorded:
16. I have read, understand and agree to the policy and terms of use as listed on the Whitman Police Department's website.*

    1. Yes
Leave This Blank:


18. 1. Receive an email copy of this form.
19. Email address

    This field is not part of the form submission.

20. Submit

* indicates a required field