Individual Aid Request Form

FFCF INDIVIDUAL AID REQUEST FORM

LEGIBLE COPY OF OFFICIAL INCIDENT REPORT MUST BE SUBMITTED FIRST OTHERWISE REQUEST WILL BE DENIED!

AID Recipient's Name: Street:

City, State, Zip:

Daytime Telephone: Fax Number: Email Address:

Aid Requested: $ Address where aid is to be sent:

LEGIBLE COPY OF INCIDENT REPORT MUST BE MAILED OR FAXED FIRST! OTHERWISE REQUEST WILL BE DENIED!

Firefighters Charitable Foundation Inc.
One West Street, Farmingdale, New York 11735
Fax: 516-249-0338

YOU MUST PROVIDE IN THE SPACE BELOW A DETAILED DESCRIPTION OF THE INCIDENT, INCLUDING DATE AND LOCATION. THE RECIPIENT OF AID MUST BE THE PERSON DIRECTLY AFFECTED IN THE INCIDENT REPORT.
FAILURE TO FILL OUT ALL PARTS OF THIS FORM CAN RESULT IN THE REQUEST BEING DENIED!