Smoke Alarm Request Form

Smoke Alarm Request Form

Sumter County Fire Rescue
300 McMath Mill Rd, Americus, GA, 31719

229-924-6603
Full Name

First NameLast Name
Contact Number
Please enter a valid phone number.
Email Address
example@example.com
Address

Street Address

CityState / Province

Postal / Zip Code
How many alarms are needed?
We are only able to install 2 per house.
Does anyone in your home have special needs, such as hearing or sight impairment.
Red Cross may provide us with strobe light or bed shaker alarms. Note this may take longer to receive.
Primary Language
If other, please explain in the comments.
Any specific date and time, which may work best? Please allow up to 3 days. We will call to confirm.

MonthDayYear
Date
Hour MinutesAM/PM Option
Smoke alarms need to be replaced after 10 years from the manufacture date.

Please note, we recieve a grant for these smoke alarms and must limit 2 smoke alarms per household. Some homes may need more. These alarms are not hard wired compatible. Smoke alarms are sold in stores and online. If located in Americus city limits, please contact Americus Fire at 229-924-3213

These alarms are not Carbon Monoxide alarms. Carbon Monoxide is a odorless, tasteless and colorless gas. It is a silent killer, if you have questions on CO please contact us for more information.

For more safety tips,

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https://www.facebook.com/sumtercountyfirerescue/
Department use:

This section is for Fire personnel
Station and Engine Assigned:

Shift on duty:

Firefighter/s installing:

How many Alarms were installed?

Signature of homeowner after install:

______________________________________________Date:___________
Should be Empty:

Smoke Alarm Request Form

300 McMath Mill Rd, Americus, GA, 31719

Department use: