Vacation Check Request

If you live within the Collierville Town limits and you would like the Collierville Police Department to conduct routine security checks of your residence while you are away for an extended period of time, please notify the department by submitting the following form. Homes for sale will only be check it if someone still lives in the residence. It may take up to 48 hours to process this request. If you have any difficulties in completing this form or question if it was submitted properly, please call 457-2500 to have department staff complete a request for you.


Address(*)

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Date of Departure (Select from calendar below)(*)


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Time of Departure(*)

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Date of Return (Select from calendar below)(*)


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(*)

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Please call (901) 457-2562 if you return earlier than indicated.


Name(*)

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Phone(*)

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Cell Phone

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Email

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Do you have an alarm service?(*)

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If yes, provide the company's name and phone number.

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Will the lights be on?(*)

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Are the lights on timers?(*)

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Will the mail/newspapers be stopped?(*)

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Doors and windows locked?(*)

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Are there pets around the residence?(*)

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Describe any vehicles on the outside of the property. Include make, model, color, and registration if possible. Indicate if the vehicle will be concealed in a garage.

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Will anyone be around the home?(*)

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If yes, who?

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Is the home for sale(*)

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What is the name of the Real Estate Agent and phone number?

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Where can we reach you?


Location (Include address, city, state, zip)

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Phone

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Does local contact have a key to residence?

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Name of Local Contact

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Local Contact Phone Number

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Comments

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Please read the following statement before submitting this form. The Collierville Police Department, per your request, will attempt to check your residence periodically. Neither the Town of Collierville, nor the Collierville Police Department assume any liability in the event of theft, loss or damage to personal or real property in or around your residence. By submitting this form, it is understood and agreed that neither the Town of Collierville or the Collierville Police Department assumes any liability with the "Vacation House Check." The resident, by accepting the "Vacation House Check," and by execution of this request understands and agrees to the provisions of this release.


Release agreement(*)

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The Collierville Police Department will not consider any requests without agreement to the release provisions listed above.


(*)


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