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ERCLC Vendor Interest Form
If you are interested in becoming an approved vendor with Eleanor Roosevelt Community Learning Center, please fill out your information, complete and we will be in touch soon!
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* Indicates required question
Email
*
Your email
Vendor Business Name
*
Your answer
Contact Name
*
Your answer
Contact Email
Your answer
Contact Phone
*
Your answer
Physical Street Address
*
Your answer
City
*
Your answer
State
*
Your answer
Zip Code
*
Your answer
Are you Currently Affiliated with ERCLC?
*
I have no affiliation with ERCLC. There is no familial relationship with an ERCLC family. I am not an employee.
I am the family member of a currently enrolled ERCLC Family. This could be a parent, grandparent, aunt, uncle, etc. of an enrolled student.
Other:
Do you provide in-person or Virtual Services?
*
In-Person Only
Virtual Only
Both In-Person and Virtual
Detailed Description of the Service
*
Your answer
Pricing (Please explain how much you charge and if you charge by month, by individual class, by semester, etc.
*
Your answer
Send me a copy of my responses.
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