Department of Veteran Affairs - Vendor Portal Self Registration Utility

Inspect the data below closely and verify that all information is accurate. If necessary go back and correct any incorrect data.

Vendor Name: Vendor has not been selected UEI: DUNS:

First Name:

Email:

Middle Initial:

Work Phone:

Last Name:

Other Phone:

Address:

Fax:

City:

Time Zone:

State:

Zip Code:

Administrator:

There are missing field(s):

A Vendor has not been selected
First Name is required
Last Name is required
Email Address is required
Time Zone is required
Login ID is required
Password is required
No administrators exist for this vendor. Click the Administrator check box to continue and become an adminstrator for your company.

Please go back and correct any missing values.

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