Smoke Alarm Request Form

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This form will be used by the citizens of Graham to request information or installation of smoke alarms in their homes.

The Graham Fire Department offers free smoke alarm inspections to city residents. Please fill out this form to request your smoke alarm inspection.

The City of Graham Fire Department also offers free smoke alarms and installation to residents inside the Graham City Limits. Those requesting free alarms should meet at least one of the following qualifications:

1. You or someone in your residence is 65 years of age or older.
2. You have children under the age of 18 in the home.
3. You or someone in your home is disabled or has a mobility impairment.
4. You or someone in your home is a United States Veteran.

Do you meet one or more of the criteria listed above? *

Yes

No, however I would like to request a smoke alarm inspection (please continue this form)

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