Smoke/CO Alarm Check, Battery Replacement or Installation Request

Anchorage Middletown Fire & EMS
Smoke/CO Alarm Battery Check, Replacement or Installation

Fill out this form to receive assistance
Date*

MonthDayYear
Date
Name of person present*

PrefixFirst NameMiddle NameLast NameSuffix
Address where detector is needed*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact Email:
example@example.com
Contact Phone Number*

Area CodePhone Number
Do you know the approximate year your home was built?
Does your home have smoke detectors*

YesNo
Do you know how many smoke detectors your home has?
Do you know which of the following type of smoke detectors your home has? (check all that apply)

Battery Operated (9 volt or other replaceable battery)Battery Operated with a 10 year litiumHard wired smoke detectorsHard wired heat detector(s)Hard wired heat detectors that are monitored by an alarm companyI don't know.Other - Please list in notes or comments below
Does your home have any natural gas or propane appliances, or an attached garage?*

YesNo
Does your home have at least one CO detector?*

YesNo
Notes or Comments:
A member of the Anchorage Middletown Fire & EMS Community Risk Reduction Divisioni will contact you to discuss your smoke detector needs. In most cases this will happen within 3-4 business days.

The Anchorage Middletown Fire & EMS Community Risk Reduction Division hours are 7am to 5pm, Monday throught Thursday.

Emergency Incidents may also hamper our ability to complete your reqeuest at a given time.
Should be Empty:

Anchorage Middletown Fire & EMS

Smoke/CO Alarm Battery Check, Replacement or Installation