Please complete the following form. When you are done, click the submit button and we will get back to you as soon as possible.

Company Information
Rates (Two Hour Minimum)

Please note that if the event is canceled with no notification to us and the ambulance arrives, the promoter will be billed a minimum of two hours to cover the wages of the ambulance crew members.

By clicking the Submit button, I am acknowledging the requested services listed above and understand that payment is due upon receipt of invoice.