*Agency Name: The name that your state has on record.
*Agency Certification Number: The certification number that your state will provide you
*Type of Service: You can choose between 9-1-1 Response with Transport Capabilities, 9-1-1 Response without Transport Capabilities, Air Medical, ALS Intercept, Hazmat, Medical Transport (which is for transfers to nursing homes or other hospitals), Rescue, Community Para-medicine, or Critical Care (Ground).
*Agency Type: You can choose between these options. Fire Department, Governmental (Non-Fire), Hospital, Private or Non-Hospital, or Tribal.
Service Area GNIS: Geographical number assigned to your agency
*Agency Number: The number that your state has provided you with. (This might be the same as your agency certification number)
*Agency State: The state your agency resides in
Fire Department ID: If you are involved with a fire department then your state will also provide you with a number for this field as well. (This is not required if you are not a fire department)
*Agency Status: Select if you are either a Volunteer Agency, Non-Volunteer Agency, or a Mixed Agency
*Tax Status: Choose whether you are a For Profit Agency, Not for Profit Agency, or Other.