YORUBA ALLIANCE ORGANIZATIONS & CLUB, U.S.A

P.O. Box 41395, Washington D.C. 20018

yorubaalliance.org

 

 

 

FOR VENDORS ONLY

 

 

 

1.     Business Name: _______________________________________________________  

            

 

2.     Contact Name: ________________________________________________________

 

4.  Email: _______________________________________________________________

 


5.  Telephone: ___________________________________________________________

 

 

6.  Address:   ____________________________________________________________

 

 

7.  City:     ______________________________________________________________

 

 

8.   State: _______________________________________________________________

 

 

9.   Zip Code: ______________________________________________________________________    

 

 

10. License Number: ________________________________________________________

 

 

11.  References:

 

S/N

Names

Age

Relationship

Address

1.

 

 

 

 

2.

 

 

 

 

 

12.  Declaration:

 

I___________________________hereby declare that the above information is given in
good faith and to the best of belief. I further declare that the Organization should use these
informations in its administration.

 

13.  Signature & Date: ____________________________________________________

 

 

Please do not write below this line.

14.  Official Use Only:

 

Date Interviewed

& Perused

 

Name

 

Post

 

Signature