2. In accordance with the Texas Administrative Code (Title 25, Part 1, Chapter 157, Subchapter C, Rule 157.41), a person or entity that acquires an AED shall immediately notify all local emergency medical service providers of the existence, physical location and type of device.
4. Reported installation must be within the City of Irving boundaries. The exact reported location/site address is required. Please use one form per AED installed.
6. Service Provider Information
8. AED Service Provider:
9. Contact Name:
11. Phone Number:
12. Email Address:
14. AED Information
16. Business/Organization:*
18. Address:*
20. City:*
21. State:
22. Zip Code:*
24. Installation Date:*
25. Manufacturer:
26. Model:
28. Serial #:
30. AED Location Description:*
Leave This Blank:


32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit Submit and Print

* indicates a required field