Fire Incident Report Request Form

Per Arizona Revised Statute § 39-121.03 “Commercial Purpose” means the use of a public record for the purpose of sale or resale or for the purpose of producing a document containing all or part of the copy, printout or photograph for sale or the obtaining of names and addresses from such public records for the purpose of solicitation or the sale of such names and addresses to another for the purpose of solicitation or for any purpose for which the purchaser can reasonably anticipate the receipt of monetary gain from the direct or indirect use of such public record. Commercial purpose does not mean the use of a public record as evidence or as research for evidence in an action in any judicial or quasi-judicial body.

This Request Meets the ARS Commercial Purpose Definition

This Request Does Not Meet the ARS Commercial Purpose Definition

Requesting Company

Name of Requestor (required)

Address (required)

City (required)

State (required)

Zip (required)

Phone (required)

Email (required)

Fax

Report Requesting (required)

Incident Report

Other

Reason for Request (required)

Service Date (required)

Time of Call

Call #

Incident Address/Location (required)

City (required)

State (required)

Zip (required)

Nature of Call (required)

Please forward report to me via (required)

Describe Other

Your Signature (required)

Confirm e-Signature

Review Electronic Records and Signatures Policy (required)

Read our Electronic Record and Signature Disclosure

I agree to use electronic records and signatures

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