Form Center

2. Please fill out this form and submit to request additional Kilgore Police patrol.
4. Type of Extra Patrol*
   -- Select One --House WatchBusiness WatchDirected Patrol

   Please select the type of extra patrol you are requesting.
6. Your Name*
8. Your Address*
10. Your Phone Number*
12. Address Needing Patrol*
14. Location of problem*
16. Span of Patrol Needed*
    Span of Patrol Needed Start Date

    —

    Span of Patrol Needed End Date
    Please note the date you will be leaving and the date you will be returning. House/Business Watches are only good for two weeks. Anything over two weeks will require an additional forms to be submitted.
18. Day of week and time when problem is occurring*
20. Emergency Contact Information*
22. Please briefly describe the problem you would like investigated.*
24. Will lights be left on?*

    1. Yes
    2. No
25. If yes, in what rooms?*
27. Will a dog be left at home?*

    1. Yes
    2. No
28. If yes, where will it be kept?*
30. Will anyone be entering or working around the residence/business while you are gone?*

    1. Yes
    2. No
32. If yes, please provide their name and purpose for being on the property.*
34. Do you have an alarm at residence/business?*

    1. Yes
    2. No
35. If yes, please provide alarm company name and phone number.*
37. Please provide information on vehicles left at location (include make, model, color and location of vehicle):
Leave This Blank:


39. 1. Receive an email copy of this form.
40. Email address

    This field is not part of the form submission.

41. Submit

* indicates a required field