Midwest Protection Agency

Patrol & security experts that give you peace of mind

Security Services Order Form

Payment by check can be mailed to:
Midwest Protection Agency, 533 Central Ave, Osseo, 55369

Or complete the following credit card information:

Customer name *

Contact Person *

Customer Address *

City *

State *

Zip Code *

Phone *

Email address *

Type of Event

Name of Venue

Address

City

State

Zip

Contact Person

Contact Phone

Dates Service is Requested

Times Service Is Being Requested

Type of Uniform Requested

Event Details and Special Instructions

Person Authorizing Security Services

Person Responsible for Payment

Credit Card Number

Expiration Date

Name on Card

CVV 3 Digit Code

Billing Adress

Billing City

Billing Zip

Please select at least one option.

By submitting this form you authorize Midwest Protection Agency, Inc. to provide security officer service for the above listed event.