PLAQUEMINES PARISH GOVERNMENT PURCHASING DEPARTMENT
8056 HWY 23, SUITE 201B • BELLE CHASSE, LA  70037
Phone: 504-297-5590 • Fax: 504-297-5599

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Vendors Application

Please complete all fields below and submit form. Fields mared with an * are required.
Note: Plaquemines Parish Government does not conduct business with any vendor where and employee of Plaquemines Parish Government or their immediate family has an interest in that business.

*Company Name:

*Your First and Last Name:

*Street Address:

*City, State, Zip Code:

*Phone Number:

Fax Number:

*Tax ID #:

*Name of officers, members or owners of concern, partnership, etc:

President:

Vice President:

Secretary/Treasurer:

*Indicated classes of equipment, supplies, materials, and/or services you sell or offer:

By submitting this form you understand that you are submitting an
electronic signature verifying all information above is accurate.