Full Name*

Police Dept. You Work for*

City*

State*
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Zip Code*

Work Phone

Home Phone

Cell Phone*

Cell Phone Service Provider*

When you provide us with your Cell Phone Service Provider, you are agreeing that Off Duty Services may send you text messages (including SMS and MMS) to the cell phone number you entered above. You also agree to pay the charges to your wireless bill or to have them deducted from your prepaid balance for this service. All text messages sent and/or received are subject to standard text messaging rates.

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