Vendors/Suppliers Interest Form

First Name*

Last Name*

Email*

Phone*

Country region (Select one)*

Address Line 1*

Address Line 2

City*

State*

Zip Code*

Business Name*

The business I represent offers the following services*: (select all that apply)

Industrial Equipment Environmental Maintenance/Services Electrical Instrumentation Supplies Other

The business I represent is:

Located in San Patricio County Located in one of the following Coastal Bend counties (Nueces, Aransas, Refugio, Bee, Live Oak, Jim Wells or Kleberg) Minority-owned Woman-owned Small business enterprise

Please provide additional details about your business

Keep me updated with email notices!*

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