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12 Auto-Filled 16 Require Input

Business Security Camera Program

AI Processing Complete

Our intelligent system has analyzed and automatically filled 12 fields from your business profile. Review the pre-filled information and complete any remaining required fields.

Auto-filled Required Fields

AI-populated from your business profile (editable)

ZIP Code * Profile Data

Applicant First Name * AI Parsed

Applicant Last Name * AI Parsed

Contact Person First Name * AI Parsed

Contact Person Last Name * AI Parsed

Contact Telephone Number * Profile Data

Contact Email Address * Profile Data

Confirm Contact Email Address * Profile Data

Name of Business in Property Being Improved * Profile Data

Type of Business * Profile Data

Your Selected Contractor - Vendor * Profile Data

Contractor's Email Address * Profile Data

Required Fields Needing Input

These fields require your manual input to complete the form

Address of Property Being Improved - Address Line 1 Required

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City Required

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Applicant Commercial Activity License Number Required

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Federal Employer Identification Number (EIN) or Social Security Number (SSN) Required

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Contact Person Title Required

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Number of Employees Required

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Legal Name of Property Owner Required

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Describe the exterior cameras you plan to install on your business property and how system will provide surveillance to public space. Please indicate the number of cameras and locations. Required

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Is there an existing camera system that you are replacing? If yes, how old is it and why you are replacing it? Required

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Describe any other security improvements you will be making and the estimated investment (if applicable): Required

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Describe your communication with the local police district (crime prevention officer or other): Required

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Total Project Cost Required

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Cost of interior cameras and interior installation (not eligible for BSCP) Required

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BSCP Project Costs Required

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Is the contractor performing the work a minority-owned business? Required

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Is the contractor performing the work a woman-owned business? Required

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Optional Enhancement Fields

Additional information to improve form processing accuracy

Address Line 2 Optional

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Police District Optional

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Additional Contractor who provided you with an estimate Optional

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Security Information

Form Target: https://httpbin.org/post
Submission Method: Server-side POST with fresh CSRF tokens
Data Handling: No persistent storage, demo data only

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