Section 1 of 1 in this document
Smoke Alarm Installation Request
*Note
- this program is only for City of Bloomington residents.
Full Name
First Name
*
Last Name
*
Location Address
Address or Location
I am the home owner and currently living in the home.
Yes
Phone Number
*
Email
Do you need assistance with installation?
Yes
No
Are your current alarms hardwired?
Yes
No
Unknown
Are your current smoke alarms working?
Yes
No
Unknown
Checkbox/Radio Group
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Any Day Of The Week
What is the best time of day for installation of the alarms?
9 a.m. - Noon
2 p.m. - 5 p.m.
5 p.m. - 8 p.m.
Any time between 9 a.m. and 8 p.m.
disregard this