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2026/2027 FAP Vendor Agreement

5 Section 10.

SIGNATURES

Name of Supplier (Home Energy Vendor)

Employer ID or SS #

Supplier Representative (Print Name)

DUNS or UEI Number

Supplier Representative’s Hand-Signature

Date

________________________________________________________________________ Owner

Designated Supplier Staff Contact Person (Print Name)

Vendor Contact Person Phone Number

Vendor Contact Person Email

Supplier Street Address

Supplier Phone Number

Town/City

State Zip Code

Mailing Address, if different from address above – Street Address or PO Box

____________________

Town/City

State Zip Code

Tri-County Community Action Program

TCCAP FAP Staff Person Signature

Date

TCCAP Executive Signature

Date