Vendor Contract Form

Date

This date will appear on the contract{s)

YYYY

Legal Name of the Company

The name that appears on legal and regulatory documents.

Short Name of the Company

This name will repeat multiple times in the "Agreement(s)"

Address of the Company

Street Number

This may be the Plot or Building Number on a street

Street Name

The name of street that appears in legal or regulatory documents.

Unit/Suite Number

Suite, Unit, or Office number within a building or premises

Postal/Zip code

City

Province/State

Country

Name of Authorized Person

Name of person who will sign the "Agreement(s)" on behalf of the Company.

First Name

Last Name

Designation of the Authorized Person

Email Address of the Authorized Person

Phone number of Authorized Person

Country

(###)

###

####

Products/Services To be provided

Please list the product(s) or Service(s) that you offer to provide to LYF Research

USFDA Establishment Identifier number (if available)

Applicable only in case of FDA related services. This number is usually available on USFDA website for Labs registered with USFDA. Example, 3002808815

Data Universal Numbering Systems (DUNS) number (if available)

This is the business number in USA

Message, Comments, Suggestions