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Donating Equipment

Request Equipment

Founding Firefighters

Requesting Equipment

Contact Information

Name
email
Department Name
Type of Department
Street Address
Address Line 2
City
State		Zip

Phone1		Phone2
Phone3		Fax
Pager		Alternate Email
Note: Your Name, email and at LEAST two phone numbers are required.

Department Information

Dept. Annual Income	(Please include fundraising and donations.)
How are funds raised?
Normal population size
Number of active volunteers
Number of paid members
Number of response vehicles
Please list years and type of response vehicles
How many square miles does your department cover?
Please describe your departments’ situation, and if applicable give an example of a dangerous situation created by a lack of appropriate equipment.
What equipment/materials are you requesting?
Would you like more information about becoming a representative of FireAid/EMSAid?	Yes No
Are you interested in finding other departments in your area in need of help?	Yes No
Do we have your permission to share your information with others?	Yes No

Privacy Policy

We use the information you provide us to assess how we can help you and other departments. We do not share your information with any other organizations without your express permission.