= Required Fields

Online Form - Vincent Graffiti Safewipe Citizens Packs

Are you a resident of the City of Vincent?
Have you been a previous recipient of a free Graffiti Removal Kit?
Has your property been defaced by graffiti?

I have undertaken to use this Safer Vincent Resource of my own free will and I agree to FULLY INDEMNIFY & HOLD HARMLESS the City of Vincent, its servants and agents from all claims, demands, actions and suits for any personal injury, death or property damage resulting from use of this product

Agree to above terms