Vendor Registration Form

Thank you for interest in doing business with the Authority.

Please complete the form below to register with the Authority's Procurement Department.

Please describe the goods/services you provide

Contact

Title

Company Name

Office Phone Number

Mobile Number

Email Address

Company Address

City

State

Zip Code

Is your remittance address different from the address above?

NoYes

Remittance Address

Is your company a Small or Small Diverse Business Enterprise certified by the Pennsylvania Department of General Services?

NoYes

Designation

Other Designation

Do you participate in any cooperative contracts or have any government contracts?

NoYes

If yes, please provide the contract number and the entity with whom you are contracted with.

If available, please provide your Philadelphia Business Activity License Number

Send me a copy of my responses

NoYes