Request for Smoke or Carbon Monoxide Alarm

Request for Smoke or Carbon Monoxide Alarm
The Bolivar Fire Rescue Department installs smoke and/or carbon monoxide alarms in residences within our fire district. There is no fee for this service; however, installations must be scheduled in accordance with our schedule and staffing. This program is provided in collaboration with the Tennessee Department of Commerce, State Fire Marshal's Office.
Name*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Residence Ownership?*

OwnRent
Residence Type?*
Does anyone in the home smoke?*

YesNo
Does the home currently have any working smoke alarms?*

YesNo
Does anyone living in the home experience mobility issues?*

YesNo
Does the home have a basement?*

YesNo
Number of Bedrooms*
Number of Stories*
Should be Empty: