Fire Rescue Billing, LLC

Structure Fire Submission Form
  • / /
  • Physical Address Required
  • Owner & Occupant Information

  • Include City, State, and Zip Code
  • What apparatus was assigned to the incident?

    List all unit numbers separated by commas. (ie., Engine 72, Engine 78)
  • HazMat Trailer, Rescue Trailer, Light Tower, etc.
  • Incident Information

  • Hours and Minutes
  • Extinguishment, Rescue, Traffic Control, etc.
  • Any equipment / gear receive damage while on scene? If so, list name, type, and cost to clean / fix / replace.
  • Describe the incident what actions you took. Be detailed as possible.
  • If you have any documents that are related to this incident that you need to include upload them here.