Department of Veteran Affairs - Vendor Portal Self Registration Utility

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

Fill in the fields below. Required fields are indicated with an "*".



* First Name:			* Email:
Middle Initial:			Work Phone:
* Last Name:			Other Phone:


Address:			Fax:
City:			* Time Zone:
State:
Zip Code:


Check this box if you are requesting an administrative account. If you are the first user to request an account for this vendor then you must be an administrator.

Administrator:

	Guest