Print this page, complete the following
information and return this form to:
information and return this form to:
Larry Isenberg, FireSmart Kootenai County
10019 Bobcat Trail Box 3
Coeur d’Alene, Idaho 83814
Name: _________________________________________________________________________
Phone number(s): ________________________________________________________________
Mailing address: _________________________________________________________________
Physical address if different than mailing address: ______________________________________
Describe your situation (example –one home on three acres with lots of thick brush . . . )
Directions to property (if necessary):
As explained on the FAQ sheet, you have three options for the work. Please mark which you think would be your
choice:
choice:
_______ I would like a FireSmart contractor to do the work
_______ I have a contractor I would like to do the work. The name of the contractor is:
_______ I will do the work myself
How did you hear about the FireSmart program? _____________________________
Working with a group of neighbors increases the effectiveness of the fuel reduction efforts.
Would you be willing to invite a few of your neighbors to your home for a short informational
presentation on the program? _________
presentation on the program? _________
 | |  |