(please print this page, complete the application and mail to: Wedington Fire Department, 13496 West AR Hwy 16, Fayetteville, AR 72704)
Date________________________
Name__________________________________________________________________
Mailing Address_______________________________________________________
City___________________________ Zip____________
Property Address______________________________________________________
City__________________ Zip____________
Telephone(Home)______________________ (Work)____________________
Name and phone of person to contact in an EMERGENCY if you are not available
Number of people that live at dwelling (Adults)_______(Children)_______