Put an X next to your choice: UNITED AMERICAN SECURITY, LLC NWH OUT-OF-TOWN SERVICE REQUEST MEMBERS ONLY – Physical check of Submission Date: _____________ home and property Member Address: _____________________________ Drive-by check Member Name(s): ___________________________ only Cell Phone #(s):______________________ _____________________ Departure Date and Time: _______________ Return Date and Time: ________________ Emergency Contacts Name Relation Phone # Access to House? List the make/model, year, color and license plate of any vehicles parked outside while gone: Input an X next to each question, under the appropriate column, to denote a response of Yes or No. Further Information YES NO YES NO Security Alarm ON? Back gate locked? Mail stopped? Newspaper stopped? When? Lights on timers? Pool service? When? Outside? Lawn service? Pets on site? Is our patrol listed as a contact for your alarm company? *We encourage you to ask a neighbor to collect your mail and/or newspapers while you’re away. List any additional instructions, pet descriptions, or other info you want us to know: completion, save the form and email as an attachment to uasnhha@gmail.com. Please note the email address begins with not USA. It stands for United American Security. UAS, DATE TIME OFFICER DATE TIME OFFICER DATE TIME OFFICER
UNITED AMERICAN SECURITY, LLC Put an X next to your choice: NWH OUT-OF-TOWN SERVICE REQUEST – MEMBERS ONLY Physical check of Submission Date: _____________ Member Address: _____________________________ home and property Drive-by check Member Name(s): ___________________________ only Cell Phone #(s):______________________ _____________________ Departure Date and Time: _______________ Return Date and Time: ________________ Emergency Contacts Name Relation Phone # Access to House? List the make/model, year, color and license plate of any vehicles parked outside while gone: Input an X next to each question, under the appropriate column, to denote a response of Yes or No. Further Information YES NO YES NO Security Alarm ON? Back gate locked? Mail stopped? Newspaper stopped? Lights on timers? Pool service? When? Lawn service? When? Pets on site? Outside? Is our patrol listed as a contact for your alarm company? *We encourage you to ask a neighbor to collect your mail and/or newspapers while you’re away. List any additional instructions, pet descriptions, or other info you want us to know: completion, save the form and email as an attachment to uasnhha@gmail.com. Please note the email address begins with UAS, not USA. It stands for United American Security. DATE TIME OFFICER DATE TIME OFFICER DATE TIME OFFICER