2. 
3. SECUREWATCH REGISTRATION
   Camera registration is simple, voluntary and free. You will only be contacted by the Bensenville Police Department if there is a crime in the vicinity of your security camera. Police may ask to view your footage in order to assist in an investigation. Information provided is used for official purposes only and will not be shared publicly. If you have any questions about this program, contact the Bensenville Police Department at (630)-350-3455
5. Contact Information
7. First Name*
8. Last Name*
10. Business Name*
12. Address1*
14. Address2
16. City*
17. State*
18. Zip*
20. Phone Number*
21. Cell Phone*
22. Email Address*
24. Camera Views*

    (Please check which are applicable)

    1. Front
    2. Rear

    1. Sidewalk
    2. Driveway

    1. Parking Lot
    2. Other
25. Number of Cameras at Location*
27. System Type*
    -- Select One --DVRPCNetworkCloud
28. Auto Overwrite?
    -- Select One --YesNo
29. Export Format
    -- Select One --.AVI.MP4
30. Export Media Type
    -- Select One --USB DriveDISC
32. If System is DVR, please provide the following information:
34. Year
35. Make
36. Model
37. Serial #
39. To be eligible to participate in the SecureWatch program the video camera must be in the Village of Bensenville
    Thank you for registering with the Bensenville Police Department SecureWatch program. The information you have provided to us will be used for investigation purposes only, and will not be disseminated for other solicitations of the Village or for any commercial purposes. If you have any questions about this program, contact the Bensenville Police Department at (630)-350-3455
41. 
    
Leave This Blank:


43. 1. Receive an email copy of this form.
44. Email address

    This field is not part of the form submission.

45. Submit Submit and Print

* indicates a required field