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Vendor Registration & Permits 

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Purchasing Services
399 Challenger Road Cape Canaveral, FL 32920
Phone: (321) 783-7831/Fax: (321) 868-2184
Email: cpa.purchasing@portcanaveral.com

Vendor Application

INSTRUCTIONS:

After completion of this form, please return to the Canaveral Port Authority (CPA) via email at cpa.purchasing@portcanaveral.com or by regular mail A W-9 must be submitted with this application
Submission of this vendor application indicates that the vendor has read and agrees with Canaveral Port Authority's terms and conditions (as revised from time to time) posted at https://www.portcanaveral.com/Business

PROOF OF INSURANCE MUST ACCOMPANY ALL VENDOR APPLICATIONS AS REQUIRED UNDER THE GUIDELINES FOR INSURANCE COVERAGE REQUIREMENTS AND COVERAGE LIMITS

**PLEASE FILL IN ALL INFORMATION ON FORM.  MISSING INFORMATION MAY RESULT IN A DELAY IN PROCESSING APPLICATION**

General Information

Please select your business type from the following (all that apply):
If you are a Service Provider, would services be provided on Port Property?
If you are a Supplier or Manufacturer, would you be making deliveries on Port Property?
Do you offer any IoT devices, Computer/Network-Controlled devices, software, or SaaS for installation or use?
Do you offer any services or hardware that can communicate with other hardware, software, or services associated with CPA or CPA Vendors?

Physical Address

 

Preferred Method of Communication

Remit to Address (Mailing Address where you would like payment sent)

 

Preferred Method of Communication

Vendor Disclosure

If any of the officers or principals of your company are employees of the Canaveral Port Authority and/or related to an employee or elected official of the Canaveral Port Authority in any capacity, please list their name(s) below:
***KNOWINGLY WITHHOLDING THIS INFORMATION MAY RESULT IN VENDOR DISQUALIFICATION***

***FOR CANAVERAL PORT AUTHORITY USE ONLY***