Vendor Registration Form

Vendor Registration

Complete form below to request to be a vendor.
Organization/Business*
Registered Name of Organization/Business (if different than above)
Contact Name*

First NameLast Name
Organization/Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Primary Phone Number*

Area CodePhone Number
Secondary Phone Number

Area CodePhone Number
E-mail*
Racial/Ethnic Group (Check Box): US Department and Urban Development reporting purposes only.

White AmericansBlack AmericansNative AmericansAsian/Pacific AmericansHispanic/Latino AmericansOther
Woman Owned Business?

YesNo
What Services would you be providing for the Niagara Falls Housing Authority?
Did your Organization/Business exist under a previous name?

YesNo
If you answered “Yes” to the question above, what was it’s previous name?
Does your Organization/Business or any of it’s employees have a vested interest in the Niagara Falls Housing Authority. If so, state the details of such vested interest.
Do you have any relatives that work for the Niagara Falls Housing Authority? “Relatives” relates to spouse, brother, sister, mother, father, grandmother, grandfather, aunt, uncle, cousin, son, daughter, in-law (of any kind: brother-in-law, mother-in-law).*

YesNo
If you answered “Yes” to the above question, please specify who you are related to and how.
Workers Comp Insurance File Upload

Cancelof
Liabilty Insurance File Upload

Cancelof
By signing this document I cerify that all the information I provided is true and accurate to the best of my knowledge.
Signature*

Clear
Should be Empty:

Vendor Registration

By signing this document I cerify that all the information I provided is true and accurate to the best of my knowledge.