Test App Form Test Form - 4/6/23 Your Name* Your Email Address* Are you a recurring customer? Please select if either apply. Yes, my business/organization or I have scheduled an officer detail within the last 90 days. Yes, I am requesting Extra Duty officers on a daily, weekly, or monthly recurring basis. Terms Rates: Standard Rate: $40.25 per hour per officer Traffic Control Job Rate: $57.50 per hour per officer Holiday Rate: $57.50 per hour per officer (holidays include: New Year’s Day, Martin Luther King Jr’s Birthday, Good Friday, Memorial Day, Independence Day, Labor Day, Veterans Day, Thanksgiving (Nov. 23 & 24, 2023), & Christmas (Dec. 25, 26, & 27, 2023) There is a three (3) hour minimum for each Officer scheduled. Please provide at least twenty four (24) hours' notice when canceling or each Officer scheduled will be paid for two (3) hours. Extra duty details are filled on a voluntary basis and the potential for unfilled requests exists. I have read and understand the Terms of Agreement. I agree to abide by Belmont rules, regulations and ordinances should my application be approved. Additionally, I will fulfill the requirements placed upon this application as expressed in the Terms of Agreement. HiddenSignature Image url Agree to Terms* Check here to agree to the above terms Payment Method*Please select your preferred method of payment and then select the PROCEED TO BILLING button Option 1: Prepayment by credit card: If you are choosing Option 1 to pay with a credit card, Extra Duty Solutions will follow up via email with an estimate (Sales Order). A ‘pay now’ link will be included to make your payment online. If you would like to pay over the phone, please call our Finance Department at 203-813-5601, then press ‘2’. Please be aware that a 3% convenience fee will apply for all payments made with a credit card. NOTE: Officer requests are never guaranteed as they are based on the Officer’s schedules and availability. Option 2: Prepayment by check, ACH or wire payment: If you are choosing Option 2 to pay with a check, ACH or wire payment - Extra Duty Solutions will follow up via email with an estimate (Sales Order). Payments will need to be received at a minimum of three (3) days before the date of the event to facilitate ample time for processing. NOTE: Officer requests are never guaranteed as they are based on the Officer’s schedules and availability. Option 3: Please send me an invoice. Upon receipt of the invoice, I will pay with a check, credit card**, ACH or wire. To guarantee this payment, I am providing a valid credit card. If I do not pay the invoice by day 30, I agree that Extra Duty Solutions can charge my credit card for the invoice amount plus a 5% late fee (late fee will replace the +3%.) Option 4: Please send me an invoice as we are a publicly traded company. This option is only available for public companies traded on a stock exchange or in an over-the-counter market. Ticker or stock symbol is required. HiddenOption 1 Option 1: Prepayment by credit card: If you are choosing Option 1 to pay with a credit card, Extra Duty Solutions will follow up via email with an estimate (Sales Order). A ‘pay now’ link will be included to make your payment online. If you would like to pay over the phone, please call our Finance Department at 203-813-5601, then press ‘2’. Please be aware that a 3% convenience fee will apply for all payments made with a credit card. NOTE: Officer requests are never guaranteed as they are based on the Officer’s schedules and availability. HiddenOption 2 Option 2: Prepayment by check, ACH or wire payment: If you are choosing Option 2 to pay with a check, ACH or wire payment - Extra Duty Solutions will follow up via email with an estimate (Sales Order). Payments will need to be received at a minimum of three (3) days before the date of the event to facilitate ample time for processing. NOTE: Officer requests are never guaranteed as they are based on the Officer’s schedules and availability. HiddenOption 3 Option 3: Please send me an invoice. Upon receipt of the invoice, I will pay with a check, credit card**, ACH or wire. To guarantee this payment, I am providing a valid credit card. If I do not pay the invoice by day 30, I agree that Extra Duty Solutions can charge my credit card for the invoice amount plus a 5% late fee (late fee will replace the +3%.) HiddenOption 4 Option 4: Please send me an invoice as we are a publicly traded company. This option is only available for public companies traded on a stock exchange or in an over-the-counter market. Ticker or stock symbol is required. Product Name** Credit card charges are + 3%.PhoneThis field is for validation purposes and should be left unchanged.