Security Home Check Card

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Last Name*		Address*
I will be away from my home from:
Departure*		Return*
I have arranged for my newspapers to be: Stopped Picked up		I have arranged for my mail to be: Stopped Picked up
By: (enter name and phone number)		By: (enter name and phone number)
My lights will be:* OnOffOn a timer
If someone has access to your home, please complete the following:
Name	Address		Phone Number
In case of emergency, I may be reached at:
Name		Phone
Address	City		State
Disclaimer Notice: The sole intent of Security and the Property Owners' Association (POA) in providing this service is to obtain the information contained herein and not to provide contractual services. The property owner acknowledges that the POA, by accepting this information, does not warrant that any services provided will prevent or minimize the likelihood of loss or assume any responsibility or liability for loss, damage, or injury to the owner's property. By submitting this form to the POA, I declare that I am the property owner at the above-stated address and that I accept the terms and conditions of this form.
By submitting this form, you are certifying that all information is correct. Please enter your initials below.*
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