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									Vendor Application

 Company:                                                               Contact:

 Address:                                                               Telephone:          -       -

                                                                        Fax:         -          -

     DBES          MBE           WBE            Other                   E-mail:

PAVA ENROLLMENT INFORMATION (Pava is an electronic payment method utilizing the VISA card platform)
 A/R Contact:                                                           Telephone:          -       -

 Primary E-mail:                                                        Secondary E-mail:

 Required supplies, equipment and services – indicate all categories that apply:

 Supplies, goods and services required in the operation of a             Maintenance services:
 correctional or healthcare facility:                                     Medical equipment or supplies
      Audiovisual equipment and supplies for education                    Office machines, equipment, supplies
      Barber/beauty shop equipment or supplies                            Pharmaceuticals
      Clothing or other items of apparel                                  Protective clothing
       Correctional equipment or supplies                                 Radio or telecommunications equipment
       Dairy products                                                     Safety equipment
       Dental care equipment or supplies                                  Shoes, boots, etc.
       Fire protection equipment or supplies                              Sporting goods, athletic equipment and products
       Food products, either fresh or canned                              Television/VCR equipment
       Food service equipment or machinery                                Other:
       Food service supplies                                         Supplies, goods and services required in the construction of a
       Furniture                                                     correctional or healthcare facility:
       Hygiene Items                                                      Construction materials:
       Janitorial supplies
                                                                          Construction equipment
                                                                          Construction services:
       Laundry chemicals

Please provide detailed description of product(s) of service(s), or attach description, e.g. catalog, sheet, to this form

                                                                                         Return by Fax: 561-443-3381 or E-mail:
                                                                                         Or mail to:
                                                                                         The GEO Group, Inc.
                                                                                         Attention: Purchasing
                                                                                         Suite 700, 621 Northwest 53rd. Street
                                                                                         Boca Raton, FL 33487

Note: Please remember to attach your company brochure, pamphlet or catalogue, along with a copy of the SBA Certificate to application.

Rev 08/09 NP                                             EQUAL OPPORTUNITY EMPLOYER                                                   PUR-310

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