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Department Name:
Contact:	*
Street:	*
City:	*
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Zip Code:	*
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Please send additional information on: (Check all that apply)
Type I Type III Type IIIL Extra Heavy Duty	Rescue Specialty Unit Remount
Chassis Type:(choose one)
Ford Chevy GMC	International Freightliner Other: Specify:
Next Expected Purchase Date
Immediate 1-6 Months 6-12 Months 1-2 Years
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What will be your role in the purchase of emergency equipment? (check all that apply)
Gather Information Write Specifications	Recommend Purchase Make Final Purchase Decision
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EXCELLANCE, Inc.
453 Lanier Road ~ Madison, AL 35758
1-800-882-9799 ~ (256)772-9321
FAX: (256)772-8792

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