Smoke Alarm Request Form To request a smoke alarm evaluation for your home, please complete the form below. Someone from NIESA will contact you. Smoke Alarm Order Form First Name Last Name Phone Email Address Street Address City Type of Residence Type of Residence Single Family Mobile Home Condo Apartment Number of Stories 123 Number of Bedrooms Type of Foundation BasementCrawlspaceSlab Do you already have smoke detectors? Do you already have smoke detectors? Yes No Are your current detectors hardwired or battery powered? HardwiredBattery Powered 12 + 3 = Submit
