<% ' FP_ASP ASP Automatically generated by a FrontPage Component. Do not Edit. On Error Resume Next Session("FP_OldCodePage") = Session.CodePage Session("FP_OldLCID") = Session.LCID Session.CodePage = 1252 Err.Clear strErrorUrl = "" If Request.ServerVariables("REQUEST_METHOD") = "POST" Then If Request.Form("VTI-GROUP") = "0" Then Err.Clear Set fp_conn = Server.CreateObject("ADODB.Connection") FP_DumpError strErrorUrl, "Cannot create connection" Set fp_rs = Server.CreateObject("ADODB.Recordset") FP_DumpError strErrorUrl, "Cannot create record set" fp_conn.Open Application("_ConnectionString") FP_DumpError strErrorUrl, "Cannot open database" fp_rs.Open "", fp_conn, 1, 3, 2 ' adOpenKeySet, adLockOptimistic, adCmdTable FP_DumpError strErrorUrl, "Cannot open record set" fp_rs.AddNew FP_DumpError strErrorUrl, "Cannot add new record set to the database" Dim arFormFields0(0) Dim arFormDBFields0(0) Dim arFormValues0(0) FP_SaveFormFields fp_rs, arFormFields0, arFormDBFields0 fp_rs.Update FP_DumpError strErrorUrl, "Cannot update the database" fp_rs.Close fp_conn.Close FP_FormConfirmation "text/html; charset=windows-1252",_ "Form Confirmation",_ "Thank you for submitting the following information:",_ "detector_request.htm",_ "Return to the form." End If End If Session.CodePage = Session("FP_OldCodePage") Session.LCID = Session("FP_OldLCID") %> Request for Smoke Detector Form

Wickliffe Division of Fire

Free Smoke Detector Program - Request Form


The Wickliffe Division of Fire, in and effort to reduce fire related casualties, offers free smoke detectors, including installation, to all residents. Fire department personnel will check your home for adequate coverage and install, reposition, or replace improperly working smoke detectors. We will also replace batteries as needed.

The Free Smoke Detector Program is available to City of Wickliffe,Ohio residents ONLY

To schedule an appointment, or if you have any questions, you may contact us by phone, e-mail, or US mail.

By phone:  (440) 943-7133.

By e-mail:  khope@wickliffefire.org

By mail:   Complete, print, and mail the following form to: Wickliffe Fire Department, 29885 Euclid Ave., Wickliffe, Ohio, 44092.

                   You will then be contacted by telephone.

                

To:

 Katie Hope, Secretary

From:
Date Requested:
Re: Submission for  Free Smoke Detector

Your Address:
Street
City, State, ZIP

Telephone Number:

Rent or Own?:

Are you over age 50?

Do you currently 
have any smoke 
detectors?

Best time of day to 
call and telephone 
numbers for each.