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2. 
4. Complete form to voluntarily register camera information.

   This one-time registration applies to Southaven City limits only and registration does not give Southaven Police Department access to any of your hardware. It is the location of the devices only.

6. Business Name
8. Primary Contact Name*
10. Address*
12. Neighborhood Name
14. 24-Hour Contact Number*
16. Email Address
18. Equipment Type*

    1. Doorbell Camera
    2. CCTV System
    3. Both
20. Recording Period

    1. Only when motion is detected
    2. Only during business hours
    3. 24 hour recording
22. Estimated Retention Period (how long before the video is overwritten?)
24. Camera Coverage

    What areas of the property do the cameras cover?

    1. Front Yard
    2. Front Entry
    3. Back Yard
    4. Side Yard

    1. Parking Lot
    2. Street
    3. Cash Registers (Business)
    4. Interior (Business)
26. By checking this box, you agree to provide the location of your cameras to the Southaven Police Department and understand you may be contacted in the future by the Southaven Police Department.*

    1. I agree
Leave This Blank:


28. 1. Receive an email copy of this form.
29. Email address

    This field is not part of the form submission.

30. Submit

* indicates a required field