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Get Alarmed Order Form for Fire Departments
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Date
Requestor Information
Fire Dept./Org.
FDID #
Contact
Phone
Email
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Street Address
City
County
Zip Code
Shipping Address
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Contact Name
Street Address
City
State
Zip Code
Order Information
How many smoke/CO combo alarms are you requesting?
How many smoke alarm brochures are you requesting?
Agreement
By requesting smoke alarms through the Get Alarmed Kansas free smoke alarm installation program by the Office of the State Fire Marshal, I agree to the following (check each following statement)
We will install smoke alarms at each location they are given away (and not hand them out to be installed by homeowners).
We will educate the homeowners on smoke alarm maintenance and fire escape planning.
We will submit the installation/liability forms to the OSFM after installation.
We will install free smoke alarms for homeowners only and not landlords or businesses.
Our organization agrees to the above terms in order to receive free smoke alarms through the OSFM Get Alarmed Kansas program.
By typing your name and date, you agree to each of the statements above.
Name
Date
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