Font Size

Smoke Detector Request

This form is used to transmit a request for Smoke Detector installation and/or Home Safety Review by the Richland Township Fire Department.

All information collected is for the intended purpose stated. We do not share or sell information collected.

Your Name*

Residence Address*

Email Address*

Phone Number*

Number of working Smoke Detectors in home*

Please provide a description of the home and the age of individuals living in the home*

I have a hearing disability and require a detector with a special alerting function

Yes

What is the best time of day to contact you

Morning

Afternoon

Evening

Anytime

What is the best way to contact you*

Phone

Confirm Request*

I understand that I am asking a member of Richland Township Fire Department to contact me using the above information for the intended purpose indicated above