YORUBA ALLIANCE ORGANIZATIONS & CLUB, U.S.A

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

www.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