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Application Requirements <br />for Ambulance Franchise <br /> <br />1. Type franchise requested: .... <br /> <br />2. Name & address of applicant: <br /> <br />Name of proposed business: ......................... <br />(Send certified copy of any articles of incorporation, partnership agree- <br />meat, certification of limited partnership, or assumed name certificate) <br /> <br />4. Training and experience of applicant: <br /> <br />(Send copy of state certification, EMT, etc.) <br /> <br />5. Copy of state certification for each ambulance(Attach) <br /> <br />6. Copy of state certification for each EMT employed(Attach) <br />7. Location and description of place of operation:_ ~ <br /> <br />8. Copy of financial statements of owner's operations in the county(Attach) <br /> <br />9. Fees for transport: <br /> Any additional charges: <br /> Number of personnel currently employed: <br /> History: previous services provided; counties serviced; standbys, etc. <br /> <br />Previous employers(References): <br /> <br />Marketing plan(target areas):, <br /> <br />Future goals: <br /> <br /> <br />