Vendor Account Registration

NOTE: To become an active business participant, fill out the required information. Once you have completed the form and selected the "submit" button, a confirmation email will be sent to you. After you receive the confirmation email, you will be able to login and complete your business listing. Once approved, your information will be added to the Employee Discount Program.
Public Business Information - This information will be listed on the website.
* Business Name:
Customer Phone Line:		Ex: (123) 456-7890
Web Address: http://		Ex: www.businessname.com
Web Sales?:	Yes No	Can a purchase be made on your website?
* Search Category:		Email to suggest a new search category
Additional Search Category:
Additional Search Category:
Additional Search Category:

Authorized Agent - The point of contact authorized by the company.
* First Name:
* Last Name:
* Phone:		Ex: (123) 456-7890
Fax:		Ex: (123) 456-7890
* Email Address:		This will be your vendor login name.
* Retype Email Address:
* Password:		6 characters minimum
* Confirm Password:

Mailing Address - For administrative purposes only. This will not be published.
* Address Line 1:
Address Line 2:
* City:
* State:
* Zip:

Agreement and Authorization*

I agree to provide the listed discount to qualified University of Oklahoma employees who provide valid proof of employment. I also understand that the Unversity of Oklahoma Office of Human Resources may discontinue the Employee Discount Program or my organization's participation in this program without notice at anytime.

* Required.