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2. Please fill out the following information for the Johnston Safe Business Program. This program allows the Johnston Police to have a place of contact and information to ensure security cameras are in working order. Disclaimer: This information is good for one year. After one year, we would ask that you fill out the information again to ensure the Police Department has the most up-to-date information.
4. Business Name:
6. Address1
8. Address2
10. City
11. State
12. Zip
14. Do you have a security system?

    1. Yes
    2. No
16. Do you have a camera system?

    1. Yes
    2. No
18. If yes, what kind of system is it?

    1. Indoor
    2. Outdoor
    3. Both
20. First Name of Contact Person
21. Last Name of Contact Person
23. Address1
25. Address2
27. City
28. State
29. Zip
31. Email Address:
33. Best phone number to be reached on?
Leave This Blank:


35. 1. Receive an email copy of this form.
36. Email address

    This field is not part of the form submission.

37. Submit

* indicates a required field