Thank you for your interest in the SecurAssist program. In order to access the valuable services available through SecurAssist, complete the following registration form. After submitting your information, you will receive a confirmation email. Once we have reviewed and approved your registration, a member of our team will call you to review your account’s information and discuss your security needs. PLEASE NOTE: the SecurAssist program is intended for use by Assist America member companies and not for individual employees.

Contact Information

One security contact and one administrative contact is required to enroll in the SecurAssist program. Names and other data collected are used internally to enable our security team to be responsive to your needs. Information is held in strictest confidence and is never shared with outside parties.

Primary Security Contact

This contact has responsibility and decision-making authority for security and safety-related matters for the company.

Primary Administrative Contact

This contact has responsibility for administrative duties relating to security management for the company.

Same info as above

Backup Contact

This contact acts as an alternate to the above individuals.

Same info as above

Office Locations

Please detail the office/facility locations where you do business.

Primary Security Contact for this Location (required)

Same info as above


Please enter information about your company’s existing security programs and needs.

Existing Security Programs (choose all that apply for each location)

Please select the security issues that are most importance to your organization at this office location:

Registration confirmation will be emailed to you.

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