18-10 Contract

VENDOR INFORMATION In order to assure that all future correspondence is directed to the correct address, assure proper ordering, expedite future payments, and in accord with LR.S. regulations, the following information must be provided with this proposal. Township of West Orange Name of Business: (Print) Joseph A. Fonzino Name of Contact Person: (Print) Correspondence Address (including zip code): Township of West Orange 66 Main Street West Orange, NJ 07052 Purchase Order Address (including zip code): same Payment Address (including zip code): same Telephone Number (including area code): (973 325-4124 Fax Number (including area code): 973 325-4005 healthdept@westorange. org E-Mail Address: Employer LD. # or S.S, #; 227-600-2396 FAILURE TO PROVIDE ALL OF THE ABOVE INFORMATION MAY RESULT IN REJECTION OF THIS PROPOSAL, -