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Click ‘Get Form’ to open the Massachusetts 500 1 Part A application in the editor.
Begin by entering the Service Number and Service Expiration Date at the top of the form. Indicate whether this is an Initial application or a Renewal, and select any upgrades if applicable.
In the SERVICE INFORMATION section, fill in your service's Name, Address, City, State, Business Phone Number, Manager Name, and Contact Person's email address.
Proceed to LICENSEE INFORMATION. Here you will provide similar details for the licensee including their name and contact information.
Complete the PARENT or ASSOCIATED COMPANIES OF OWNER section by listing any related companies. Specify your Service Ownership Type from options like Sole Proprietor or Corporation.
Indicate if your service is operated by a state agency and select the Level of License you are applying for (BLS, Intermediate, Paramedic).
Fill in details about your hospital affiliations and total number of vehicles and EMS personnel in the respective sections.
Finally, review all entries for accuracy before signing under penalties of perjury at the bottom of the form.
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