Receive a 180 Piece Emergency Preparedness Kit! Here's How!

First step is to complete a quick 90 second questionaire!

Once the questionnaire is completed, qualified respondents will be selected to receive a limited number of 180 pc. Emergency Preparedness Kits for viewing valuable free safety awareness information. By submitting the questionnaire your name will be entered and you may be selected.

Question Title

* Which of the following concerns you the most?

Home Fire

Carbon Monoxide Poisoning

Smoke Damage

Water Damage

Home Invasion

Question Title

* How long do you think it would take for your family to escape a home fire?

10-13 Minutes

7-10 Minutes

4-6 Minutes

0-3 Minutes

Question Title

* Do you have?

Children

Pets

Both

Question Title

* Married, Living Together or Single?

Married

Living Together

Single

Question Title

* Your Occupation

Question Title

* Spouse's Occupation

Question Title

* Age range

Under 18

18-24

25-34

35-44

45-54

55-64

65+

Question Title

* Do you own or rent your home?

Own

Rent

Question Title

* Contact Information (If selected you may be contacted at the # listed)

Name

Address

City/Town

State/Province

ZIP/Postal Code

Receive a 180 Piece Emergency Preparedness Kit! Here's How!

First step is to complete a quick 90 second questionaire!

Question Title

* Which of the following concerns you the most?

Question Title

* How long do you think it would take for your family to escape a home fire?

Question Title

* Do you have?

Question Title

* Married, Living Together or Single?

Question Title

* Your Occupation

Question Title

* Spouse's Occupation

Question Title

* Age range

Question Title

* Do you own or rent your home?

Question Title

* Contact Information (If selected you may be contacted at the # listed)

Question Title

* Best number to reach you at?

Question Title

* Who's post did you get this survey from?