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Vendor Application

Please complete the vendor form with your contact details. Your information will be kept for future consideration. Note: Vendors may need to be licensed by the Iowa Racing and Gaming Commission.

Company Name

Contact Name

First Name

Last Name

Contact Title

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Company Website

Type of Business/Good/Service

MWBE Certificate Number

Other Diverse Business Certification

If Yes, Please Enter Certification