Smoke/Carbon Monoxide Detector Certification

2. <Font Color=#FFFFFF><center><p><H1>Millville Fire Department</H1></p> 420 Buck Street Millville, NJ 08332 <p>Phone: 856-327-3334&nbsp &nbsp &nbsp Fax: 856-327-2319 </Font color>

   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. <center><H4><i>Office Use Only</i></h4></center>

    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. <center><font color=#DF013A><h1>Payment Schedule</h1><p>$45 - 10 or More Business Days</p><p>$90 - 3 to 9 Business Days<?p><p>$161 - 2 or Less Business Days</p><p>Days are calculated from the date that the request is received to the closing date.</p><p>Failure to complete all requested information may delay the inspection.</p>

    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. <center><font color=#DF013A>www.MillvilleFire.org<p>Committment-Innovation-Excellence-Passion</p></fontcolor>

    www.MillvilleFire.org

    Committment-Innovation-Excellence-Passion

Leave This Blank:


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

    This field is not part of the form submission.

47. Submit Submit and Print