2. FULL NAME*
   PLEASE PROVIDE US YOUR FULL NAME
4. ARE YOU THE *

   1. OWNER
   2. RENTER

   PLEASE INDICATE IF YOU ARE THE OWNER OR RENTER OF THE PROPERTY
6. YOUR E-MAIL ADDRESS*
   PLEASE PROVIDE US WITH YOUR EMAIL ADDRESS.
8. WOULD YOU LIKE TO BE ADDED TO OUR EMAIL LIST?*

   1. YES
   2. NO

   OUR EMAIL LIST WILL ALLOW YOU TO RECEIVE MARGATE POLICE DEPARTMENT MONTHLY NEWSLETTERS, EVENT INFORMATION AND OTHER CRIME AND SAFETY TIPS.
10. YOUR PHONE NUMBER*
    PLEASE PROVIDE US WITH THE BEST CONTACT NUMBER TO REACH YOU IN ORDER TO SCHEDULE YOUR SECURITY SURVEY.
12. WHAT TIME FRAME WILL BE THE BEST FOR AN OFFICER TO SCHEDULE YOUR SURVEY? *

    1. MORNING (8AM - 4PM)
    2. EVENING (4PM -8PM)

    ONCE YOU HAVE SUBMITTED THE FORM YOU WILL BE CONTACTED BY A MEMBER OF OUR COMMUNITY RELATIONS UNIT TO SCHEDULE THE SURVEY BASED ON YOUR AVAILABILITY.
14. Address*
    YOU MUST BE A MARGATE RESIDENT
16. City*
17. State*
18. Zip Code*
Leave This Blank:


20. 1. Receive an email copy of this form.
21. Email address

    This field is not part of the form submission.

22. Submit

* indicates a required field