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Ambulance and Medical Equipment Sales  
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Company or Organization    

Contact name 

Type of service    

Number of ambulances in service 

Phone  

Fax      

E-mail   * Do no omit

Address 

City     

Postal code   

Country     

  I wish to receive information on the following items:         

Stretchers

Vehicles for the handicaped

Chairs

Ambulances     Type I    Type II   Type III             

 From year       to  

Fire Trucks

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Revised: 05/24/07