Please complete where applicable:
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Vehicle/Equipment Type Requested: *
Name (Typically submitted by an Emergency Responder Department Head, City/Regional Government Manager or local government official) *
Email *
Type of Requesting Department (Fire Department or Ambulance, EMT, First Aid Squad) *
Name of Requesting Department (Fire Department or Ambulance, EMT, First Aid Squad)
Address *
Phone number *
Size/Population of Emergency ResponseArea (Please include square miles/kilometers  of First Response Coverage Responsibility and population of residents)
Current size of Department (Please include number of volunteers, Paid Employees. List of current vehicles/equipment, age of vehicle to be replaced)
Vehicle/Equipment Requested
(Please be specific/detailed - I.e., Fire Engine/Pumper, Ladder Truck no longer than X length, Ambulance etc.)Help us/Help You: Please provide a detailed description of your Department/Organization’s current situation that requires assistance. Can your organization provide any monetary assistance in partnership with EOH to deliver the Lifesaving Vehicle/Equipment to your Community? Please attach pictures of your current vehicle/equipment needing to be replaced. Tell us your story, we are with you! Engines of Hope strives to connect All Volunteer and Paid/Professional First Responder Organizations in the USA with our fellow Brother and Sister Firefighters and Emergency Medical Units throughout the Americas.
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