Submit Smoke Alarm Request Form            
Smoke Alarms are a lifeline for you and your family. It is the goal of Union County Fire Department to ensure every home in Union County has working smoke alarms. By taking a few minutes to complete this request form, you’d not only be helping us, but yourself. In order to accomplish this, we are providing smoke alarms at no cost, and collecting information from you.
Name:
Best Contact Number:
Physical Address, Street Number:
Street Name:
City:
Zip Code:
How many working smoke alarms do you currently have in your home?
How often do you test your smoke alarms?
Do you have a fire escape plan?
What type of residence do you live in?
How many stories does your home have including a basement?
Do you own or rent your residence?
How many people live in the house and what age?
  Under 5 years old
  5 - 18 years old
  18 - 65 years old
  65 years and older
Are there any person(s) living in the home with Physical Limitations that may prevent from being alerted or escaping?
Would you allow a member of Union County Fire Department to install the new smoke alarms at no cost to you?    
What time of day would be best to contact you?
Would you be interested in a Firewise Home Risk Assessment that can be used to help protect your home from wildfires?    
I hereby declare that all the information furnished above is true to the best of my knowledge.
Working Smoke Alarms SAVE LIVES!!
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