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Applications by program

Ambulance and hospital fleet

Ambulance application

Ambulance renewal application

Hospital fleet application

In addition to the application, we need the following:

  • 3-5 years of currently valued hard copy carrier loss runs
  • Driver schedule to include full driver name, DL #, DL state, date of birth, and date of hire
  • MVR's if available
  • Vehicle schedule to include year, make, ambulance manufacturer, type (I, II, or III), original cost new, current value, and lienholder information (for example - 2003 Ford AEV type II OCN $72,000 / ACV $28,000 on lien)
  • If new or newer venture (less than 3 years in business), please also include resumes of the firm principals, a copy of their business plan, and current financial statements

Return to the agent portal to upload the completed application.

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Contact us if you have any issues and need a hard copy emailed, faxed or mailed to you.