2. Madison Connecticut Police Department
   9 Campus Drive, Madison, CT 06443 (203) 245-2721
4. Property Information
6. Type of Property

   Check the boxes that apply

   1. Business

   1. Residence

   1. Other
8. Property Name:
10. Property Address
12. Property Phone #:
13. Property Hours:
14. Days of Operation
16. Contact Information
18. Contact
    Person 1
19. Phone #:
    Person 1
21. Email Address:
    Person 1
22. Cell Phone #
    Person 1
24. Alternate Person
    Person 2
25. Phone #
    Person 2
27. Email address
    Person 2
28. Cell Phone #
    Person 2
30. Are you part of a neighborhood/business watch program?

    1. Yes
    2. No
31. Name of Group:
33. System Information
35. System Brand
36. Model:
38. Number of Fixed Cameras:
39. Number of PTZ Cameras:
40. Number of Storage Days:
42. File Format:

    1. MPEG4
    2. H.264
    3. Other
43. Windows Media Player Compliant?

    1. Yes
    2. No
45. Upload sketch
    Sketch building entrances, exits, parking lots, and appropriate camera fields of view or other comments. Note: Orientate north to the top of the sketch.
46. Contact (203) 245-2721
    Contact the Madison Police Department for additional information.
Leave This Blank:


48. 1. Receive an email copy of this form.
49. Email address

    This field is not part of the form submission.

50. Submit

* indicates a required field