City of Dickson Fire Department Application for Rural Fire Protection Service

City of Dickson Fire Department Application for Rural Fire Protection Service
NOTICE:

Property MUST be within a five (5) mile radius of one of our fire stations in order for us to provide rural fire protection.

Location of Fire Stations:

Fire Station #1 - 101 Church Street - Dickson, TN 37055

Fire Station #2 - 501 Pringle Drive - Dickson, TN 37055

Fire Station #3 - 2579 Highway 70 East - Dickson, TN 37055
Applicant Information
Applicant's Name*

First NameLast Name
Applicant's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Applicant's Phone Number*
Please enter a valid phone number.
Applicant's Email
example@example.com
Property Information
Service address where you want Rural Fire Protection*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Type of home
Can house be seen from the road?
What is the color of the house?
Number of stories in your house
Exterior type of house
Does your property have a pond, outbuilding, barn, or any other outside structures?
Value of Property
Location of mailbox
Name on mailbox
Payment for Rural Fire Protection Service
Please provide mailing address to send invoices for Rural Fire Protection Service

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
By signing below I understand I am making application for Rural Fire Protection Service as offered by the City of Dickson, Tennessee. I understand and agree this rural fire protection will be governed by the attached Policies and Procedures. I also understand this application is not effective until accepted by the City of Dickson, Tennessee.
Rural Fire Protection Service Policies and Procedures
Signature

Clear
You will be notified once your application is reviewed. Additional information will be needed to complete your file. That information will be provided to you once your application is approved.
Should be Empty:

City of Dickson Fire Department Application for Rural Fire Protection Service

Applicant Information

Property Information

Payment for Rural Fire Protection Service