The Providence � Enterprise Partnership with the Lafitte Community

							                                                  Vendor Registration Form


Company:

Contact:

Address:

City:                                           State:                                 ZIP:

Phone:                                          Cell:                                  Fax:

Email:                                                                                 Web:


Louisiana Business License?                     Union Shop?                            Business Type:
               Yes                                         Yes                                   Corporation
               No                                          No                                    Partnership
                                                                                                 Individual
Business Specialty:                                                                              Joint Venture
               General Contracting                                                               Other
               Specialty Trades
               (Electrical, Plumbing, Painting, HVAC, etc.)
               Supplies
               Other services (Please describe below)



Number of Years in Business:


Providence is committed to increasing HUB (Historically Underutilized Business) vendor participation.
Is your business 51% owned & controlled by one of the following HUB groups? (Please check one)
               African-American                            Hispanic
               American-Indian                             Female-Owned (non-minority)
               Asian-American                              None of the above


What is your bonding capacity?                  What is your target volume for a single project?
               Under $50,000                               Under $50,000
               $50,000 - $100,000                          $50,000 - $100,000
               $100,000 - $300,000                         $100,000 - $300,000
               $500,000 - $1 million                       $500,000 - $1 million
               $1 million - $5 million                     $1 million - $5 million
               Above $5 million                            Above $5 million




                                              PROVIDENCE COMMUNITY HOUSING
           1050 S. Jefferson Davis Pkwy, Suite 301      New Orleans, LA 70125   Phone: (504) 821-7222    Fax: (504) 821-7213
                                                http://www.providencecommunityhousing.org
Relevant project experience:


   Name of Project                Owner                     Architect              Contract Amount           Date Completed




Client References:




Bank References:




                                                                Submitted By:

                                                                Name:
                                                                Company:
                                                                Date:



* This form may be emailed to Sombra Davis Williams @ SDavis@archdiocese-no.org (to check boxes, double
  click the box and change default value to “checked”).

      Please note that Providence Community Housing may request your assistance in verifying any of the
       information provided.




                                            PROVIDENCE COMMUNITY HOUSING
         1050 S. Jefferson Davis Pkwy, Suite 301      New Orleans, LA 70125   Phone: (504) 821-7222   Fax: (504) 821-7213
                                              http://www.providencecommunityhousing.org