City of Victoria Form Center

2. The Victoria Fire Department provides free smoke alarms to residents in need.
   Smoke alarms are installed on a first-come, first-serve basis to homeowners. During the installation period, firefighters will also identify possible fire hazards. To sign up to receive a free smoke alarm, please complete the following form.
4. Name*
5. Phone*
7. Address*
9. City*
10. State*
11. Zip Code*
13. Do you currently have a smoke alarm?*

    1. Yes
    2. No
14. How many levels is your home?*

    If you have a multi-story house

16. Number of bedrooms*
17. How many occupants reside in the home?*
Leave This Blank:


19. 1. Receive an email copy of this form.
20. Email address

    This field is not part of the form submission.

21. Submit

* indicates a required field