Alchemer Survey

Applicant Information Page

1. Agency/Company/Organization Name: *This question is required.

2. Contact Information: *This question is required.

Contact Person Name:
Contact Person Title:
Contact Person Email Address:
Confirm Email Address:
Contact Person Phone Number:
Contact Person Mobile Phone Number:

3. Organization Director Information: *This question is required.

First Name:
Last Name:
Title:
Email Address:
Phone Number:

4. Organization Information: *This question is required.

Organization Street Address:
Organization Apt/Suite/Office:
Organization City:
Organization State:
Organization Zip Code:

5. Are you a registered vendor in Edison? *This question is required.

6. If yes, please provide your Edison Supplier ID number:

6. Please upload the completed and signed Competitive Requirements document posted with this opportunity. The Competitive Requirements must be signed by someone with signatory authority. *This question is required.

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7. It is imperative that each applicant review the entire Sample Grant Contract with their legal counsel prior to applying and notify the State in advance if they cannot accept any terms or conditions. Do you take any exceptions to the Sample Grant Contract language? *This question is required.

8. If yes, please upload a document that provides the sections of the contract and the exceptions. *This question is required.

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