Video File Request Form Requestor Information

Requestor’s Name: Title:

Agency Name: Badge Number:

Agency Address:

Email: Phone Number:

Information Store Address:

City / State:

Description: Please include details of the event. Details are very helpful and will assist us in accurately responding to your request.

Please minimize the duration of your video request in terms of date(s) and time(s). The length of the time requested directly impacts the speed of video distribution and download.

Time Span: Date of Event: Start time: End Time:

Camera View:

Due Date: Time Zone:

This form is not for employee use.

AM PM

Police Report / Incident Number:

AM PM

Printed Name Date

Signature

This completed form is to be submitted to the following email address:If you have NOT received a request confirmation from Syncplicity in 5 days, please send an update request to the email listed above.

Enter "Video Request" as the email Subject. Scan and attach this form to the email, before submitting. Attach any supporting documentation or information as a separate attachment.

Do NOT submit this form to a company store. Our store employees do not have access to security video located in their stores.

USAExVideoRequest@SpeedyInc.com

DIRECTIVES:

• DESCRIPTION: Explain the details of the event including but not limited to: What occurred, what you are looking for, anddetails of individuals involved.

• EMAIL: Provide your agency email address if you are representing a police department or law firm, for example.

• TIME SPAN: Please provide specific start and end times for video. We ask that you minimize the amount of video requestedas shorter time spans allow us to retrieve and distribute video to you more efficiently, as well as allows faster download timesfor you, the requestor.

PLEASE READ THE FOLLOWING BEFORE SUBMITTING YOUR REQUEST:

• Entry Door(s)• Lobby• Safe

• Rear Exit (if available)• Exterior (if available)

• CAMERA VIEW: Specify the camera view from the list of standard views below. We ask that you keep requests to a singlecamera view, however we do understand there will be exceptions.

*We do not have camera views specific to teller windows or work stations.

• Security video, when available, will be released to both law enforcement agencies and certain non-law enforcement parties inthe sole discretion of Speedy Cash/Rapid Cash. Speedy Cash/Rapid Cash may require a subpoena prior to any release ofsecurity video.

• Neither the completion of this form nor the service of a subpoena guarantees that security video is available or can/will beprovided. No guaranty is made, either expressly or impliedly, regarding the granularity or quality of any security video.

• Any security video provided pursuant to this process remains the exclusive property of Speedy Cash/Rapid Cash and allrights in and to the video are the property of Speedy Cash/Rapid Cash.

• The release of any portion of the security video by the requestor to a third party without Speedy Cash/Rapid Cash’s expressconsent, or court order issued by a court with proper jurisdiction is strictly prohibited.

FREQUENTLY ASKED QUESTIONS:

How long is security video retained at a Speedy Cash/Rapid Cash stores?

Assuming the store is equipped with security video cameras and all equipment is functioning properly, security equipment may retain video for 30 days. Various factors specific to the individual store determine the retention and availability of video after the first 30 days.

Can anyone obtain Speedy Cash/Rapid Cash security video?

No. Speedy Cash/Rapid Cash will provide security video to law enforcement agencies in its sole discretion and in compliance with all relevant laws and regulations. To protect the confidentiality of its Customers, Speedy Cash/Rapid Cash will not release security video to private citizens.