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Smoke Alarm Request Form

2. Danville Fire Department Smoke Alarm Request Form

4. 600 Lynn Street
   Danville, VA 24541
   (434) 799-5226

6. The goal of Danville Fire Department's "Get Alarmed Danville" Smoke Alarm Program is to install smoke alarms free of charge in the homes of residents of Danville that cannot physically or financially do so for themselves. If you meet this criteria and do not have working smoke alarms, please complete and submit the information below.

8. Applicant Name:*

10. Street:*

12. Telephone:*

13. Cell Phone (Optional):

15. 
    A Danville Fire Department member will be contacting you regarding your request.
    

17. (Rev. 2/15)

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19. 1. Receive an email copy of this form.
20. Email address

    This field is not part of the form submission.

21. Submit

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