City of Temple Terrace Customer Service

2. 
3. Temple Terrace Fire Department Smoke Alarm Installation Request
5. Program Information:
   The City of Temple Terrace Fire Department has partnered with the American Red Cross to provide free smoke alarms to city residents. This program is for residential use only and does not apply to commercial structures. The Temple Terrace Fire Department will do an assessment of the existing smoke alarms you have in your home and install new/additional smoke alarms as needed.
7. The smoke alarms being installed have a 10 year sealed battery that does not need to be changed. The smoke alarm is good for 10 years at which time you will replace the whole unit. These units provide audible notification only and may not be effective for individuals who experience reduced hearing. Special smoke alarms to accommodate those who experience reduced vision or hearing may be available upon request.
9. Smoke alarm applicant / location installation information.
11. First Name*
12. Last Name*
14. Street Number*
15. Street Name*
16. Street Type*
17. Apt #
19. City*
20. State
21. Zip*
23. Cellular Telephone*
24. Home Telephone
26. Best time of day to be contacted.*
    -- Select One --AnyMorningAfternoon
27. Best time of day to install alarms?*
    -- Select One --AnyMorningAfternoon
28. Disabilities?*
    -- Select One --NoneVisualHearingOther
30. Additional Information:
32. Do you own or rent?*

    1. Own
    2. Rent
33. How many adults live in the home?*
    -- Select One --1234 or more
34. How many children live in the home?*
    -- Select One --01234 or more
Leave This Blank:


36. 1. Receive an email copy of this form.
37. Email address

    This field is not part of the form submission.

38. Submit

* indicates a required field