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Vendors Application

2. Company Name

4. Address

   For inquiries, mail outs, etc.

6. City

7. State

8. Zip Code

10. Remittance Address

    Address where payments are to be mailed.

12. City

13. State

14. Zip Code

16. Phone

17. Fax

19. Email

20. Federal ID Number

22. Please Note:
    The Plaquemines Parish Government does not conduct business with any vendor where an employee of the Plaquemines Parish Government or their immediate family has an interest in that business.

    The Plaquemines Parish Government does not conduct business with any vendor where an employee of the Plaquemines Parish Government or their immediate family has an interest in that business.

24. Names of Officers, Members or Owners of Concern, Partnership, Etc.

26. President

28. Vice President

30. Secretary / Treasurer

32. List classes of equipment, supplies, materials, and/or services you sell or offer:

Leave This Blank:


34. 1. Receive an email copy of this form.
35. Email address

    This field is not part of the form submission.

36. Submit

* indicates a required field