Midwest Protection Agency
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(763) 421-2966
Midwest Protection Agency
Patrol & security experts that give you peace of mind
Prisoner Guarding Order Form
Agency Name
*
Contact Name
Agency Address
City
State
ZIP
Phone number
Fax Number
Email address
*
Prisoner Name
Inmate Number
Social Security Number
DOB
Sex
Male
Female
Height
Weight
Hair Color
Eye Color
Name of Facility
Address
City
State
ZIP
Contact Name and Phone
Room Number (if known)
Requested Start Date
Requested Start Time
Current Charges
Criminal History
History of Assault
Yes
No
History of Escape
Yes
No
Visitors Allowed
Yes
No
If Yes, Who?
Phone Privilege Allowed
Yes
No
Special Instructions
Person Authorizing this order
Please select at least one option.
There is a twenty-four-hour minimum charge for all prisoner guarding services. You may request current rates by calling (763) 421-2966. When placing this order with Midwest Protection Agency, you agree that Midwest Protection Agency will not be liable for medical costs associated with emergency, or nonemergency medical care or pre-existing medical conditions while in Midwest Protection Agency’s custody. All prisoner medical costs, including, but not limited to, the costs of transportation to and from any medical facility shall be paid by the customer agency. You also agree that Midwest Protection Agency is authorized to obtain emergency and/or routine medical treatment for the prisoner whenever deemed necessary.
*
Submit
