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2. First Name*
3. Last Name*
4. Street Address*
6. City*
7. State*
8. Zip Code*
9. Phone Number*
11. Email Address
12. Street Address*
    Street Address

    Street name you are requesting trailer to be deployed on. Example: 200 Block Lemonwood Drive
13. Direction of travel *
    -- Select One --NorthSouth EastWest
14. Type of Request*
    -- Select One --Speeding Traffic CountOther
16. Comments
17. Violation usually occur on the following*
    Violation usually occur on the following Start Date

    Violation usually occur on the following Start Time

    —

    Violation usually occur on the following End Date

    Violation usually occur on the following End Time
    *Please note deployment hours are between 6:00 am-8:00 pm only.
19. I understand to the following (Please Check)*

    1. A trailer will not be deployed in an area where no safe zone exists to park the trailer.
    2. Applications will be reviewed and approved by the Chief of Police or designee.
    3. Application will be approved on a first come - first served basis.
    4. Results are for informative and awareness purposes only.
    5. Results can take up to 3-5 business days to generate.
21. Electronic Signature*
24. Do you agree?*

    By clicking "I agree", you agree and acknowledge that 1) your application will not be "Signed" in the sense of a traditional paper document and 2) By signing in this alternate manner, you agree that your "electronic signature" is valid and binding upon you to the same force and effect as a handwritten signature.

    1. I agree
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26. 1. Receive an email copy of this form.
27. Email address

    This field is not part of the form submission.

28. Submit

* indicates a required field