Vacation Notification

Dear property owner,

Please take this time to fill out the following vacation contact information data form in order for us to notify our patrol force that your property will be vacant. In addition, please provide us with at least one local contact in case a problem arises at your property while you are away.

Note: Your submission will be sent securely and you will be briefly redirected to a HTTPS secured site. The IP address of your computer will be logged. Your information is sent directly to the Billerica Police Dept. If you would prefer to call the police station to pass on this information you may call (978) 671-0900 x172.

Proprietor:
Address:
Telephone:
Email:
Emergency Contact(s) Or Keyholder(s)
Contact One
Name:
Address:
Telephone:
Contact Two
Name:
Address:
Telephone:
Contact Three
Name:
Address:
Telephone:
*Dates
Leave Date:	(mm/dd/yyyy)
Return Date:	(mm/dd/yyyy)