Glendale Medic Program - Business

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For More Information, click here to view/download the brochure.

If you have additional questions regarding this program please call (818) 548-4041.

Please correct the field(s) marked in red below:

1

Business Name
(Business or DBA)

 *
2

Glendale Location
(Street Address, City, Zip Code)

 *
3

Type of Business
(Retail, Restaurant, Attorney, etc.)

4

Applicant's Name & Title
(Business Owner, Manager, etc.)

 *
5

Contact Phone Number

 *
6
GWP Account Number
 *
7
Number of Full and Part-Time Employees
 *

Cost of GLENDALE MEDIC for Businesses

Retail, professional, manufacturing or other non-residential uses:

I-10 employees (full or part-time) - $60 per year
For each additional 10 employees (or portion thereof) $24 per year

 

Membership is for a period of one year from our acceptance of your application.

8
Title
 *
* All information is subject to verification. Coverage does not begin until the Glendale Fire Department
approves your application.
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