Smoke Alarm Installation Request

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First name:
Last Name:
Email Address:
Phone Number:
Physical Address:
How many floors/levels does your home have?
How many bedrooms does your home have?
Do you have smoke alarms in your residence? (Yes / No)
If so, are any of them currently malfunctioning? (Yes / No / Not Sure)
Would you like for us to install the alarm for you? (Yes / No)