Apply to Operate a Stretcher Transportation Service

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Personal Information Personal Information on this form is collected under the authority of Section 31 of the Freedom of Information and Protection of Privacy Act, R.S.P.E.I. 1988, Cap.F-15.1. If you have any questions about the collection, or use of this personal information, you may contact: Access and Privacy Services Office at 902-569-7590, or apso@gov.pe.ca.

Identification

Type of Application

Fill in the operator's business name and mailing address in the fields below.

Business/Organization Name

Contact First Name

Contact Last Name

Address 1

Address 2

City, Town, or Community

Province

Postal Code

For example C1B 0X1 or 12345

Country

Telephone 1

For example 902-555-5555

Telephone 2

For example 902-555-5555

Fax Number

For example 902-555-5555

Email Address