Smoking Area Ashtray Installation Permission Request Form
Complete this Smoking Area Ashtray Installation Permission Request Form to request authorization for installing ashtrays in a designated smoking area. Please provide all required details to facilitate review and approval.
Applicant Full Name
*
First Name
Last Name
Applicant Email Address
*
example@example.com
Contact Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Organization or Department
Smoking Area Location
*
Number of Ashtrays Requested
*
Type of Ashtray (if specified)
Please Select
Wall-mounted
Freestanding
Tabletop
Other
Proposed Installation Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Reason for Request and Additional Details
*
Upload Site Photo or Diagram (optional)
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Submit Request
Should be Empty: