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PLC:

a0045l

Agency:

plainfield fire department

For:

smoke home inspections

Phone:

908-753-3446

Address:

315 central avenue
plainfield, new jersey 07060

*Required Field

Payment Information

*Requestor Name:

Middle:

*Last:

*Property/Location to be Inspected:

Block & Lot (optional):

*Name to appear on Certificate:

*Dwelling Type:

One Family

Two Family

We "Only" inspect One & Two-family dwellings as required by Fire Code

*Seller Name:

Seller Phone Number (optional):

(### - ### - ####)

Realtor Name (if applicable):

Realtor Agency (if applicable):

Realtor Phone (if applicable):

(### - ### - ####)

Mg= Magnesium

CO= Carbon Monoxide

*Choose your payment type:

Please provide a valid email address to receive electronic documents

*Email Address:

Notes:

*I acknowledge:

To complete this process you must call Fire Prevention at (908) 753 -3446 to assure the transaction is approved.

Payment Amount

*Payment Type:

Enter Payment/application Fee Amount :

Subtotal:

$0.00

Total:

$0.00

Billing Information

*First Name:

Middle Initial:

*Last Name:

*Billing Address:

*City:

*State/Province:

*Zip:

*Country:

*Phone Number:

*Credit/Debit Card:

(enter the full card number without any dashes or spaces)

*Expiration Date:

*Card Security Number:

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