Please fill out the form below. Note: an asterisk (*) indicates a required field. Full Name *Address *Type of Structure *Single FamilyApartmentCondoCommercialLand Line PhoneCell PhoneAlternate PhoneNearest Cross Streets *Number of Floors (excluding basement) *1234Select the most accurate description of your garageAttachedDetachedNoneDo you have a fire alarm system? *YesNoIf yes, permit numberSelect Location of your oil tank *BasementOutside below gradeOutside above gradeNo oilOtherSelect the major sidingAluminumBrickAspestosWoodVinylOtherSelect location of electrical meter facing front of houseFrontBackLeft sideRight sideInsideSelect location of gas meter/shut off facing front of houseFrontBackLeft sideRight sideInsideNo gasSelect the most accurate description of your basementFinishedUnfinishedHalf finishedNo basementDoes your basement have an outside entrance?YesNoN/AIf a neighbor has keys to your home, list their addressAny auxiliary power sources present?GeneratorSolarOtherLocation of disconnectList any petsAny residents who have special conditions that the fire department and EMS personnel should be aware of when responding to this address (i.e., medical conditions or disabilities).Child under 18 years of age or elderly or disabled individual who reside at this addressMaleFemaleYear of birthLocation of bedroomChild under 18 years of age or elderly or disabled individual who reside at this addressMaleFemaleYear of birthLocation of bedroomList of hazardous materials such as propane, chlorine, gasoline. Please be as accurate as possible listing the name of material, quantity, and location storedIs there anything else you think we should know when responding to your address?If you would like to receive an email receipt of this form submission, please enter a valid email address in the field belowSend Message HEADQUARTERS 50 Cold Spring Rd, Syosset, NY 11791 (516) 921-0728 STATION 2 156 Woodbury Rd, Woodbury, NY 11797 Phone: (516) 921-0728 STATION 3 205 S Oyster Bay Rd, Syosset, NY 11791 Phone: (516) 921-0728