HAVING TROUBLE SELLING YOUR AMBULANCE? LET US HELP!

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Telephone	A phone number is required.
	VEHICLE INFORMATION
Year
Make	____________________________ AEV Braun Braun NW Crestline Coach Demers E-One Excellance Frazer Horton Life Line Marque McCoy Miller Medtec Medix Miller Coach National Osage PL Custom Premier Road Rescue Southern Taylor Made Tri-Star Leader Wheeled Coach Medic Master Other / Unknown Remount Peach State Remount Life Star Remount Arrow Remount US Coachworks Triton Custom Truck & Body Works 1st Priority Renaissance Doctor Down Malley Industries Foundation American Specialty Vehicles
Model
Actual Mileage
Box Length
Engine Type	____________________________ Gasoline Diesel Turbo-Diesel LNG or Hybrid
Transmission	____________________________ Automatic Manual
Drive System	____________________________ 2 Wheel Drive 4 Wheel Drive
Cab Access	____________________________ Walk Through Non Walk Through Window only
Inverter	Yes No
	VEHICLE CONDITION
Overall Condition	__________________ Like New Average Needs Work
Has this vehicle been wrecked?	Yes No
Are maintenance records available?	Yes No
Are you the original owner?	Yes No
Additional Information (including any additional options, enhancements, known defects, past repairs, etc.):
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