Smoke-Free Rental Housing

Property Submission Form

Name(Required)

First Last

Property Name

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Are all of your living units 100% smoke-free? (required to be on map)

Yes

Do you prohibit smoking on decks, patios and balconies?

Yes

Do you prohibit smoking a certain number of feet from the building?

Yes

Does your smoke-free policy prohibit vapor product use indoors as well?

Yes

Vapor Product Policy Explanation if not 100% prohibited in living units:

Total Number of Units(Required)

Email(Required)

Phone(Required)

Message

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