Federal Excess Equiment - Online Request Form

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Federal Excess Equipment
Online Request Form

Please fill out the following form as completely as possible. When all information has been entered, click the Submit Request button at the bottom of the page.
* indicates a required field.

Section I - Identification of Applicant and Officer Information

Legal Name of Fire/EMS Agency: *

Federal Employer ID Number:

PA Tax Exempt Number:

Mailing Address (Street/PO Box): *

City/Town *

Zip Code *

Officer Phone (w):

Officer Phone (h):

FAX No.:

County *

Township:

PA Forest District:

Officer Name: *

Officer Title: *

Officer Email Address: *

Confirm email address: *

Fire Chief Name:

Fire Chief Phone:

Check here if you wish for the Chief to be the primary contact.

Applicant Classification:

Volunteer Fire Dept
Emergency Services

Wildfire Crew
Other:

Section II - Equipment Request

Type of Equipment Requested:	4 x 4, 1-Ton Pickup	4 x 4, Blazer
	6 x 6, 2 1/2 Ton Truck	6 x 6, 5 Ton Truck
	Other types of equipment, described below:

Title Options: * (Check only one)	We are only interested in Property in which the title transfers to the Fire Dept. (DoD Firefighter Property)" />
	We are interested in titled or non-titled equipment (FEPP or DoD Firefighter Property)

Please describe how you intend to use requested equipment:

Does your organization currently have any Federal Excess / DOD Firefighter vehicles from
the Bureau of Forestry? Yes No

I certify that to the best of my knowledge the information provided on this form is true and correct.

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