Vendor Registration Form

Please note: This data is not automatically recorded into a database. Each entry is received, verified, and manually entered into an internal database. Please do not use hyperlinks for fields.

LANta Vendor Registration

Company Name

Street Address

Address 2

City

State

Zip code

Contact Name

Contact Phone

Contact Email

Contact Fax

Tax Identification Number

This field is required if you have been awarded a contract by LANTA or have submitted an invoice for payment. Individuals should provide their social security number.

Other - Product/Services Offered

Please complete if \"Other\" was selected under Product/Services Offered

Number of Employees

Age of Firm (years)

Annual Gross Receipts

NAICS Code/Classification

VA Certified Veteran-Owned Small Business

Yes

Service Disabled Veteran-Owned Small Business

Yes

Registered DBE

Yes

If Yes to Registered DBE

Black Americans, which includes persons having origins in any of the Black racial groups of Africa

Hispanic American, which includes persons of Mexican, Portuguese, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race

Native Americans, which includes persons who are American Indians, Eskimos, Aleuts, or Native Hawaiians

Asian-Pacific Americans, which includes persons whose origins are from Japan, China, Taiwan, Korea, Vietnam, Laos, Cambodia, the Philippines, Samoa, Guam, the U.S. Trust Territories of the Pacific, and the Northern Marianas

Asian-Indian Americans, which includes persons, whose origins are from India, Pakistan, and Bangladesh

Women, regardless of race, ethnicity, or origin

Other, individuals found to be disadvantaged by the Small Business Administration Pursuant to Section 8(a) of the Small Business Act

DBE Certification Number

State

Captcha *

reCAPTCHA is required.

	Routes & Schedules
	Tickets & Fares
	EBS Stop Locator
	myStop bus tracker
	Status & Service Alerts

Vendor Registration Form

Register your business here to receive announcements regarding relevant procurement opportunities with LANTA.