In order for us to gain a better understanding of who you are and what you do, please complete the following questionnaire. After reviewing your information, we will then proceed to the next step. Please don't hesitate to call if you have any questions. First Name: Last Name: Title: Department: Phone: Ext: Fax: Email: Email 2: Address: Address 2: City: State: ZIP: Country: I am a EMT-B EMT-T EMT-P EMS Instructor EMT-I Firefighter Physician Law Enforcement Officer Nurse Other I represent a: Volunteer Department Paid/Career Department Combination Emergency Department Law Enforcement Department Type: Fire/EMS Fire Only EMS Only Department Size: 10-25 26-50 51-75 76-100 101-150 150+ Number of EMS Calls per Year 10-25 26-50 51-75 76-100 101-150 150+ Number of Fire Calls per Year 10-25 26-50 51-75 76-100 101-150 150+   Does the Name Iron Duck Denote Quality to you?   Are you aware that we can screen-print or embroider your Dept.'s name onto many Iron Duck products?   Have you used Iron Duck Products before?     What Iron Duck Products do you currently use?   Are there any products that you would like to see Iron Duck carry?   Have you seen, or heard of a product idea that you feel would have a place in the EMS Industry?   How can we improve our service to you?   What is the biggest challenge that you face in performing your job in the streets?   Enter any comments you would like to make       About Iron Duck | Mission Statement | Contact Us Privacy Statement | New Distributor Applicationtion