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  Instructions
There are two parts to the registration form, Personal Information and Organization Information. If you are registering as the contact person for an organization, complete both the Personal Information and Organization Information sections. If you are registering as an individual, complete the Personal Information section only, then answer “No” to the question “Are you Affiliated with an Organization?

 
 
 
Register 
Personal Information
Name:*
               
Salutation First Name Middle Name Last Name
Title:
Title
Email:*
Confirm Email*
Address:

           
City State/Province Postal Code/Zip
Phone:*
       
Phone Ext.
Fax:
What Program Area are you interested in?*

Organization Information
Are you Affiliated with an Organization? Yes No
List the official and legal name of your agency (as stated on Agency's Seal or Charter):
Agency Name:*
Note: Certain funding opportunities are only open to specific agency types (i.e. Nonprofits, Government Entities, Educational Institutions, etc.). Be sure to read the eligibility requirements for the chosen funding opportunity.
Agency Type:*
Enter EIN Number as assigned to your agency by The Internal Revenue Service (IRS)
Agency EIN-Number:
Format =XX-XXXXXXX
Enter Fulton County Vendor Code Number (Note: Only for agencies who are currently funded or have received previous funding from Fulton County Government):
If you are a current vendor with Fulton County and need to make any address changes to your Vendor information, please contact Keisha Massey in the Purchasing and Contract Compliance Department 404-612-1010. New agencies that are awarded grant funding must register with Fulton County as an official vendor. Registration is required before grant payments can be released. To get to the Vendor Self Service System from the internet, enter the following URL address: https://fultonvendorselfservice.co.fulton.ga.us
Fulton County Vendor Code Number:
Agency Main Address
Note: The Agency Main address may be listed in Fulton County publications/ Directories.
Agency Main Street Address:*
       
Agency Main Suite
Agency Main City/ State/ Zipcode
           
Main City Main State Main Zip Code
Select the Fulton County Commission District for your agency (as of January 1, 2015).
Fulton County Commission District Locator Instructions:
1. Go to: http://www.fultoncountyga.gov/commissioners
2. Go to right side menu and look for the following verbiage: “Not sure what district you're in? Enter your address below to find out!”
3. Enter street address
4. Enter City
5. Select Go
Note: If the address entered is registered in Fulton County, the results will show an address match and list the NEW Fulton County Commission District as of January 1, 2015 (i.e. District 1, 2, 3, 4, 5, or 6).
Fulton County Commission District (As of January 1, 2015)
Agency Mailing Address
NOTE: ALL GRANT – RELATED CORRESPONDENCE WILL BE MAILED TO THIS ADDRESS, INCLUDING PAYMENTS.
Agency Mailing Address:*
       
Mailing Address Suite
Agency Mailing City/State/Zip
           
Mailing Address City Mailing Address State Mailing Address Zip Code
Agency Contact Information
Agency Main Contact:
           
Salutation First Name Last Name
Position/ Title for Agency Main Contact:
Agency Main Number:*
       
Agency Main Phone Extension
Agency Fax Number:
Agency E-mail Address:
Agency Website
Agency Board Information
Board Chairperson:*
               
Salutation Board Chair First Name Board Chair Middle Name Board Chair Last Name
Board Chair Telephone Number:*
       
Board Chair Phone Extension
2nd Authorizing Official:
               
2nd Official Salutation 2nd Official First Name 2nd Official Middle Name 2nd Official Last Name
2nd Authorizing Official Telephone Number:
       
2nd Official Phone Extension

Verify Submission
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