Smoke/Carbon Monoxide Detector Certification

2. Millville Fire Department

   420 Buck Street Millville, NJ 08332

   Phone: 856-327-3334      Fax: 856-327-2319

4. Block
5. Lot
6. Closing Date*
   Closing Date

   Closing Date
8. Owner's Name
10. Property Address*
12. Real Estate Agency*
14. Real Estate Agency Phone*
16. Contact Name and Phone Number (Date of Inspection)*
    If something comes up and we can't make it, who do we call?
18. Email Address for Certification Receipt
    This is Mandatory.

22. Office Use Only

24. Date Request Received: _____________________
25. Received By: ______________________________
27. Scheduled Date/Time: ______________________
29. Amount Due:
30. $45
31. $90
32. $161
34. Date/Time Faxed to Accounts Receivable: _____________________
40. Remarks

42. Payment Schedule

    $45 - 10 or More Business Days

    $90 - 3 to 9 Business Days

    $161 - 2 or Less Business Days

    Days are calculated from the date that the request is received to the closing date.

    Failure to complete all requested information may delay the inspection.

44. www.MillvilleFire.org

    Committment-Innovation-Excellence-Passion

Leave This Blank:


46. 1. Receive an email copy of this form.
47. Email address

    This field is not part of the form submission.

48. Submit