Service Request Agreement Client Contact Information **Valued Clients Please be advised that any cancellation of service within less than a 24 hour notice will result in a 6 hour minimum cancellation charge.** Any Service Request being made in less than 24 hours of the start time of an assignment shall be considered EMERGENCY SERVICE and emergency rates will apply. Company/Chain Name (required) Your Email (required) Your Name (required) Your Title (required) Your Address-City-State-Zip Your Phone (required) Job Details Site Name (required) Shopping Center Name Site Address (required) Site City (required) State ---ALAKAZARCACOCTDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY Site Zip Site Phone Site Contact Service Time Zone ---EasternCentralMountainPacificAlaskaHawaii Service Dates # of Guards Start Date End Date Start Time End Time Days Service Type Job 1 ---ArmedUnarmedArmed and UnarmedUnarmed Suit-TieArmed Suit TieUnarmed Patrol VehicleArmed Patrol VehicleLoss PreventionFire WatchUnarmed Body GuardArmed Body GuardOther Job 2 ---ArmedUnarmedArmed and UnarmedUnarmed Suit-TieArmed Suit TieUnarmed Patrol VehicleArmed Patrol VehicleLoss PreventionFire WatchUnarmed Body GuardArmed Body GuardOther Job 3 ---ArmedUnarmedArmed and UnarmedUnarmed Suit-TieArmed Suit TieUnarmed Patrol VehicleArmed Patrol VehicleLoss PreventionFire WatchUnarmed Body GuardArmed Body GuardOther Job 4 ---ArmedUnarmedArmed and UnarmedUnarmed Suit-TieArmed Suit TieUnarmed Patrol VehicleArmed Patrol VehicleLoss PreventionFire WatchUnarmed Body GuardArmed Body GuardOther Job 5 ---ArmedUnarmedArmed and UnarmedUnarmed Suit-TieArmed Suit TieUnarmed Patrol VehicleArmed Patrol VehicleLoss PreventionFire WatchUnarmed Body GuardArmed Body GuardOther Job 6 ---ArmedUnarmedArmed and UnarmedUnarmed Suit-TieArmed Suit TieUnarmed Patrol VehicleArmed Patrol VehicleLoss PreventionFire WatchUnarmed Body GuardArmed Body GuardOther Job 7 ---ArmedUnarmedArmed and UnarmedUnarmed Suit-TieArmed Suit TieUnarmed Patrol VehicleArmed Patrol VehicleLoss PreventionFire WatchUnarmed Body GuardArmed Body GuardOther Job 8 ---ArmedUnarmedArmed and UnarmedUnarmed Suit-TieArmed Suit TieUnarmed Patrol VehicleArmed Patrol VehicleLoss PreventionFire WatchUnarmed Body GuardArmed Body GuardOther Comments & Instructions. Please be specific. (required) Reason for Security Agreement Understanding I understand and agree with Nationwide Security Service's 6 hour minimum cancellation fee. YES Form Submitted By ---Client Filling out FormGary on Behalf of ClientKeith on Behalf of ClientEric on Behalf of ClientRoy on Behalf of ClientGeorge on Behalf of ClientDan on Behalf of ClientAustin on Behalf of Client