EmailMeForm
Request Information for Your Department
Only those authorized to make decisions should fill out this form. Typically, this would be the Fire Chief, President, Treasurer, or Secretary.
Department Name:
*
Mailing Address:
*
Phone Number:
*
Federal Tax ID Number:
*
Contact Person
Name:
*
Title:
*
Email Address:
*
Phone Number:
*
Average Number of Responses Per Year:
Structure Fires:
Auto Accidents:
Hazardous Materials:
Has your state, county, municipality, etc. authorized your department to bill for services? Please explain.
Do you have any specific questions we can answer?
