Application for Technology/Information Vendors

Please complete this online application by September 2, 2011. If you have any questions please email rbaade@millneck.org.

You will be contacted about the status of your application soon after it is submitted. If your application is selected, you will receive a confirmation letter, contract and other important information which must be returned with payment by September 16, 2011 or a late registration fee will incur.

*Technology/Information Vendor

*Name:

*Address:

*City

*State

*Zip

*Phone:

*Email

*Tax ID#

*Description of Technology/Information

*Required