Blue Empress Video Request Form

Blue Empress Video Request Form

Authorized Requests Only
To ensure the integrity of our services, it is imperative that all information provided in connection with this video request is accurate and truthful. Any false or misleading information submitted will result in the immediate rejection of the request, and no further action will be taken to fulfill the video request.
Requester's Name

First NameLast Name
Someone will contact you regarding this request.
Provide a good contact number
Please enter a valid phone number.Format: (000) 000-0000.
Please provide an email address where the request link can be sent.

Confirmation Emailexample@example.com
Organization
Provide the organization you are with
Provide the report/incident number for the video.
Please select one
Incident Date and Time

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Hour Minutes
Start Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Hour Minutes
End Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Hour Minutes
What is the name of the business where the cameras are located?
Address where the cameras are located?

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What are we looking for?
Should be Empty: