Community Surveillance Partner Registration Form

Community Surveillance Partner Registration Form

Please answer the following questions to register your surveillance cameras with the Randolph County Sheriff’s Office.
ResidenceBusiness
If a business, name of business:
Name of owner:

First NameLast Name
Driver's License number including state.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail
Phone Number

Area CodePhone Number
Less than 1 week1 to 2 weeks2 to 4 weeksUp to 60 daysUp to 90 daysUp to 6 monthsUp to 1 yearMore than 1 year
USB (thumb drive, etc.)CD/DVDWireless/Cloud
1 to 56 to 1010 or more
YesNo
MotionDaylight onlyDarkness only24/7
FrontSideRearStreet/Vehicles
If this is a business, please provide emergency/after-hours contact information:
Name:
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
What brand is your system?
YesNo
If yes, name of company:
Once you submit your application, you will recieve a copy of your submission via email.

Thank you!
Should be Empty: