EmailMe Form - Lisle Park District Vendor Form

Federal Tax ID or Social Security # *

Individual or Legal Business Name *

Address *

Street Address City State / Province / Region Postal / Zip Code Country / Region

Contact Name *

First Last

Contact Phone Number *

### - ### - ####

Email Address *

Does this business meet the criteria of any of the options below as defined by the Business Enterprise for Minorities, Women, and Persons with Disabilities Act? Check all that apply. *

Minority-Owned Business Enterprise (MBE)

Women-Owned Business Enterprise (WBE)

Person with Disabilities-Owned Business Enterprise (PDBE)

Veteran-Owned Small Business (VOSB)

No

Does this business hold a certificate for any classifications indicated above? *

Yes

No

Name *

First Last

Title *

Date *

MM / DD / YYYY