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2. Registration type*

   1. Business

   1. Residence

   1. Other
4. If other, please describe:
6. Business name
8. Contact name*
9. Email address*
11. Phone number*
12. Alternate phone number
14. Number of external cameras
15. Hours recorded each day
16. Amount of data retained
18. Type of surveillance system*

    1. Close Circuit

    1. IP-Enabled
20. Is your surveillance system monitored by an alarm company?*

    1. Yes

    1. No
22. TERMS OF USE*

    All information provided to the Fort Myers Police Department is protected under Florida State Statute Chapter 119 and is exempt from public records request.
    
    This program does not guarantee the Fort Myers Police Department the right to the information recorded on your camera(s) and you can revoke police access to your system at any time.
    
    Your information will be stored and in the event a crime occurs in your area, a detective may contact you to ask to view your camera(s).
    
    

    1. I have read and agree to the terms of use.
24. Electronic Signature*
    Please type your full name - First, Middle, Last
Leave This Blank:


26. 1. Receive an email copy of this form.
27. Email address

    This field is not part of the form submission.

28. Submit

* indicates a required field