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2. 
3. The Westland Fire Department is always looking for feedback on the service they provide. Please take a moment to fill out this short form to let us know how we did and what, if anything, we can do to improve the service we provide to you.
5. All information provided in this form is subject to Freedom of Information Act requests subject to State law.
7. First Name
8. Last Name
10. Street Address
12. City
13. State
14. ZIP Code
16. Phone Number*
17. Email Address*
19. Date of Service
    Date of Service
21. Please rate our service, with 1 being poor and 10 being excellent.
    -- Select One --12345678910
23. Any additional comments?
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25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit

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