Vendor Registration Form

Vendor Registration Form
Vendor Name
Company/Organization Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Company/Organization Point of Contact

First NameLast Name
Phone Number*
Format: (000) 000-0000.
Point of Contact E-mail
example@example.com
Company/Organization Website
YesNo
Vendor Cost: $500.00 You will be invoiced. For information or questions please contact:

Juliette M. Parker

CONNPAC Treasurer

City of Groton Police Department

295 Meridian Street

Groton, CT 06340

(860) 446-4154
Should be Empty: