SECURITY VIDEO REQUEST FORM (LAW ENFORCEMENT AGENCY)

SECURITY VIDEO REQUEST FORM (LAW ENFORCEMENT AGENCY (“LEA”))
This form is to be completed by Law Enforcement Officers/Law Enforcement Agencies ONLY. When available, World Oil Corp. or its relevant subsidiary or affiliate (such entity, “World Oil”) may provide security footage containing video/digital images (hereinafter the “video”) for the limited purpose of assisting you in your investigation. The video is proprietary and confidential to World Oil. You may not modify the video and/or images in any way, reproduce or publicly display, perform, distribute or otherwise use the video and/or images for any public or commercial purpose without World Oil’s express written consent. Any use of the video and/or images on any other website or networked computer environment for any purpose is strictly prohibited. If available, the video will be provided electronically via a cloud-based storage file. In cases where excessive video files are required, an external storage device may be used and a fee may be charged back to the requesting party.
Attach signed request on LEA letterhead here:*

Cancelof
Name of Requester (First and Last Name):*
Name of Law Enforcement Agency:*
Mailing Address:*
Telephone Number:*
Email Address:*
example@example.com
TRANSACTION/INCIDENT INFORMATION:
Address of World Oil facility (Address, city, state, zip):*
Start Date and time of transaction/incident (local time):*

MonthDayYear
Date
Hour MinutesAM/PM Option
End Date and time of transaction/incident (local time):*

MonthDayYear
Date
Hour MinutesAM/PM Option
Camera views requested:*
Description of individuals/vehicles involved (if known):
Acknowledgement:

*By checking here, I affirm that the information provided herein is true and correct.
Type Name*
Today's Date*

MonthDayYear
Date
Should be Empty:

SECURITY VIDEO REQUEST FORM (LAW ENFORCEMENT AGENCY (“LEA”))