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2. 
3. SAVE-A-LIFE SMOKE ALARM DISTRIBUTION CAMPAIGN
   
   

   Request Form 

5. Single Family homeowners may request a free 10-year sealed battery smoke alarm for homes that are not required to have hardwired electric smoke alarms. This service is NOT available for homes that are for sale. 

7. Homeowner’s name: *
9. Address:*
11. Phone Number:*
12. Email:
14. Do you currently have working smoke alarms in your home?:

    1. Yes
    2. No
15. Will you need Fire Department Personnel to install the alarm?

    1. Yes
    2. No

17. Request for the installation of battery-operated smoke alarms service. This service is NOT available for homes that are for sale. 

19. Smoke alarms save lives. Smoke alarms that are properly installed and maintained play a vital role in reducing fire deaths and injuries. If there is a fire in your home, smoke spreads fast and you need smoke alarms to give you time to get out.

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21. 1. Receive an email copy of this form.
22. Email address

    This field is not part of the form submission.

23. Submit

* indicates a required field