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Fire Services Report Request

Fees: $70+HST

Payment: Online payment is now available. Once you have submitted your form, you can process your payment immediately with a VISA or MasterCard, or choose to pay with a cheque by mail.

Questions: If you have any questions or require assistance, please contact Leamington Fire Services at 519-326-6291 ext. 3249.

Company Name

Contact Name

Company Street Address

City/Town

Province

Postal Code

Phone Number

Contact Email

Date of Incident

Incident Address

Property Owner Name

Property Owner Street Address

City/Town

Province

Postal Code

Please upload a signed letter of request

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Allowed extensions pdf, jpg, jpeg, png

Will you be paying by cheque or online with credit card?

Cheque

Credit Card (Online)

Privacy Statement: Personal information on this form is collected under the authority of the Municipal Act 2001 P.S.O. c45 and for the issuance of insurance information in the Municipality of Leamington. Questions about the collection of this information can be directed to the Manager of Legislative Services/Clerk, Municipality of Leamington, 111 Erie Street North, ON N8H 2Z9. 519-326-5761.

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