Delran Fire Department

Please read and complete the entire application. The Delran Fire Department will contact you upon completion of this application to arrange a date and time for installation

(*) Denotes required fields
(**) Denotes required if you have existing detectors

Name*

Address*

City*

State* Zip*

Daytime Phone*

Nighttime Phone*

E-mail Address*

*How many floors are in your home? Does the home have a basement?

*How many people reside at your home?:
Ages: 0-14: 15-24: 25-64: 64-Over:
*Are there any existing smoke detectors in your home?: **If so, How old?(Check back of detector):

By submitting this form the applicant hearby releases the Delran Fire Department of any liability pertaining to the performance of the smoke detector(s) installed or maintained in the event the smoke detector fails to perform properly during a fire or any other conditions the smoke detector was designed to operate in. The applicant also agrees to release the Delran Fire Department of any liability pertaining to damage that may result during or after the installation of the smoke detector(s).

*Signature: Type Name

Download Printable Application

Application For Smoke Detector(s)/Batteries