Smoke Alarm Install
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date Requested (MUST BE GREATER THAN 24 HOURS IN ADVANCE)
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
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How many bedrooms does your home have?
How many people live at the house?
How many residents under the age of 18?
How many residents Over the age of 65?
I attest that I am not a landlord, contractor, or business.
I Agree
I understand and agree that through the effort of the MONTGOMERY COUNTY ESD NO. 10 / MAGNOLIA FIRE DEPARTMENT and its representatives (MFD), I am being provided a free smoke detector as a public service. I understand that the MFD does not guarantee or endorse this brand of smoke detector. I also understand that the MFD is not a seller, manufacturer or dealer in smoke detectors. In exchange for accepting a free smoke detector and installation, I agree not to make any claim or demand or file any lawsuit against the MFD, or any agent of for any injuries, damages, costs or expenses claimed to have resulted from the smoke detector or installation of the smoke detector, and I hereby release and discharge the MFD or any agent of from any liability for such claims. It is my intention and understanding that this release extends to injuries or damages caused by the MFD sole or joint negligence. I further understand that for the smoke detector to be effective batteries must be replaced on a regular basis and they must be installed correctly. This release from liability is binding on me, my family, my heirs, successors and assignees.
Signature
Please verify that you are human
*
Which Station
Please Select
Smoke Alarm 181
Smoke Alarm 182
Smoke Alarm 183
Smoke Alarm 184
Smoke Alarm 185
Smoke Alarm 186
Smoke Alarm 187
Smoke Alarm 188
Smoke Alarm 189
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