🚨Smoke Alarm Assistance Request Form🚨

🚨SMOKE ALARM ASSISTANCE REQUEST FORM🚨
Today's Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
The current issue with my smoke alarm is:

Other
Comments:
If the above options do not match or, if you have additional information or questions, please provide them here to help us best assist you.
When one smoke alarm goes off, do they all go off? If yes, they are likely interconnected and will require assistance by a licensed electrician.
What is the age of your smoke alarms?
Smoke Alarms have a ten (10) year lifespan, we recommend replacing all smoke alarms that are ten years or older.
How many smoke alarms do you have?
What is the highest ceiling height where smoke alarms are installed in your home?
Red Cross Smoke Alarm Assistance Program Available http://www.redcross.org/nwhomefire

If you need financial assistance with installing or replacing smoke alarms, the Red Cross and its partners will install a limited number of free smoke alarms for those who cannot afford to purchase smoke alarms or for those who are physically unable to install a smoke alarm. If you would prefer to reach out to them, please do not complete this form and simply follow the above link to their site instead and they will assist you from here.

Benton County Fire District #4 does not have smoke alarms or batteries available to provide to the public at this time.
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🚨SMOKE ALARM ASSISTANCE REQUEST FORM🚨