HomeMy WebLinkAbout2891 - State of Arizona - Agreement - Purchasing Cooperative AgreementARIZONA STATE PURCHASING COOPERATIVE AGREEMENT
State Cooperative Member Contact Information
Name of Organization:
Name of Contact Person: Qualification: (Click the appropriate Box in either the Political
Subdivision or Non-Profit categories)
Political Subdivision: 0 Non-Profit Organization: 0
Title of Contact Person: □Federal □Other
Agency/Gov't Educational □Healthcare
Institution Institution
State □Tribal Nation
Telephone of Contact Person: □Religous
County □ Fire District Organization
□City/Town □Water District □Charity
Telephone of Office: □Public School □Other:□Other:
E-mail address of Primary Contact Person:
E-mail Address of Secondary Contact:
(If possible, please provide a general email address that can be forwarded to the contact person and that will not change should
the contact person leave the organization. The person receiving email from the State Procurement Office at the address above
needs to be responsible to forward the information to other interested parties at your organization as needed.)
Physical Address:
Mailing Address (if different from the physical address):
Federal ID Tax Number:
*Non-profit entities must attach proof of non-profit status with the agreement
Please notify the State Procurement Office of any changes to this information.
ARIZONA STATE PUCHASING COOPERATIVE AGREEMENT
Updated 2/14/2023
Page S of S