Purchasing Cooperative of America



PERSONAL DETAILS

FirstName

LastName

UserName

Several special characters are allowed, including space, period (.), hyphen (-), apostrophe ('), underscore (_), and the @ sign.

Please enter your desired username. Upon approval you will be given a link to create a password.

Email

PhoneNumber

WHO REFERRED YOU

Examples: company name & salesperson, email form PCA, ad in which paper? website you discovered us on, etc.


-- VENDOR DETAILS --

DUNS NUMBER

If you do not have one, put 0

UEI

If you do not have one, put 0

FEDERAL EIN NUMBER

COMPANY NAME

COMPANY WEBSITE URL

D/B/A

Doing Business As" - It's also referred to as your business's assumed, trade, or fictitious name. A DBA is different from your name as the business owner, or your business's legal, registered name. If none, type: None.

FAX

ZIP CODE

JOB TITLE

COUNTRY

STATE

CITY

ADDRESS

If non-U.S., please put full address here.

CATEGORIES

you may select up to 5 categoris +/or 'other'. (use other to type - in option not listed in deop-down.) To select multiple enteres, hold down the 'ctrl' key and choose your selection.

MINORITY DESIGNATION

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