Chief Troy Tanner

MESQUITE POLICE DEPARTMENT BUSINESS ALERT NOTIFICATION FORM DATE: ____________________

BUSINESS NAME: __________________________________________________________________ BUSINESS ADDRESS:__________________________________________ MESQUITE, NV 89027 BUSINESS PHONE: (702) ______ - ___________

FAX: (702) ______ - ___________

_______*Yes, I would like to have my business signed up with the National Center for Missing and Exploited Children, ADAM Program to receive fax alerts of missing children in our area to assist in the effort of locating missing and endangered children. I understand that I may cancel and remove my business from the list by going to the NCMEC web page.

*Email Address:_______________________________________________________________ RESPONSIBLE PARTIES: 1. NAME: ____________________________________________________________ HOME ADDRESS:___________________________________________________ HOME PHONE: __________________ CELL PHONE:____________________

2. NAME: ____________________________________________________________ HOME ADDRESS: __________________________________________________ HOME PHONE: __________________ CELL PHONE: ____________________

3. NAME:_____________________________________________________________ HOME ADDRESS:___________________________________________________ HOME PHONE:___________________ CELL PHONE:____________________

Do you have an alarm system?

YES ______

NO______

ALARM COMPANY NAME:___________________________________________________ ALARM COMPANY PHONE:__________________________________________________

Rev 10/2011 MPD

695 Mayan Circle ♦ Mesquite, Nevada 89027 ♦ 702.346.5262 ♦ Fax 702.346.5537