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Vendor Registration

 

Vendor Registration

Please complete the following fields.  When you are done, click the submit button and your registration form will be sent to the Director of Purchasing.

Date (format mm/dd/yyyy):   
Vendor Name: 
Vendor Address: 
 
 
Contact Person: 
Federal I.D. or Social Security #: 
Email Address: 
Web Address: 
Telephone Number: 
Fax Number: 
Type of Organization (select one):
Corporation Proprietorship
Joint Venture Partnership
Other - If other, please describe:
Number of Years in Business: 
Minority Business Enterprise: Yes No
If yes, what type: 
List products or services your company provides:
 

Questions or comments about this form?  Have something to add, but didn't find the appropriate field to enter your information?  Call or email us after you complete the form and click the "Submit" button.

814-393-2233 or rpold@clarion.edu