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4PSSI

Public Safety Services 1-800-350-7774

APPLICATION FOR SERVICE - PRIVATE EVENT

We appreciate your interest in our services. Please verify with the rental facility the minimum number of guards and hours they require for your event. If this event is held at a rental facility, the person on the facility agreement is recognized as the responsible party. Please complete and save this form prior to returning it to security@4pssi.com or fax to 1-877-464-2518

RESPONSIBLE PARTY

Name (Last, First)
rp_name

Address, City, State & Zip Code
rp_address

Mobile Phone
rp_mobile

Home Phone
rp_home

Email
rp_email

EVENT INFORMATION

Facility Name
ei_name

Facility Address, City, State & Zip Code
ei_address

Date of Event
ei_event_date

Occasion
ei_occasion

Number of Attendees
ei_n_attendees

Facility is reserved
ei_reserved

From
ei_reserved_from

To
ei_reserved_to

Time Party Begins
ei_time_begins

Time Party Ends
ei_time_ends

Time Alcohol Service to Cease
ei_time_alcohol

SERVICE HOURS One security guard is required for every 100 guests. Regular hourly charge per security guard $25.00

Security Guard # 1

Start Time
sh_start_1

End Time
sh_end_1

Security Guard # 2

Start Time
sh_start_2

End Time
sh_end_2

Security Guard # 3

Start Time
sh_start_3

End Time
sh_end_3

Security Guard # 4

Start Time
sh_start_4

End Time
sh_end_4

COMMENTS

comment

EMERGENCY CONTACT (Other than Customer)

Name (required)
ec_name

Mobile Phone (required)
ec_mobile

FORM COMPLETED BY

Name (required)
fcb_name

Date (required)
fcb_date

Riverside Base: 455 W. La Cadena Drive # 18 Riverside, CA 92501 Admin: 500 W. Graham Avenue # 354 Lake Elsinore, CA 92531

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