Vendor Registration

Company/Organization Name *

Business Type: *

Contact Person *


First	Last

Title

Address *

Street AddressCityStateZip Code

Phone: *

-
Area Code	Phone Number

Fax Number:

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Area Code	Phone Number

E-mail *

KIR! Vendor Fee (Before August 10th): *

Non-Profit ($25 USD)

Small Business ($50 USD)

Corporation ($100 USD)

KIR! Vendor Fee (After August 10th):

Non-Profit ($40 USD)

Small Business ($75 USD)

Corporation ($150 USD)

*You will be charged a 4% processing fee. It will be listed as Tax on checkout!