Broward Health Vendor Registration System
Create Account
Name of Company:
*
Vendor ID (Tax ID / SSN / EIN):
*
Enter number ONLY for one of following to represent your business
Select ID Type:
*
TaxID
SSN
EIN
Other
Select a type that represent your business number
CONTACT INFORMATION:
First Name:
*
Last Name:
*
Contact Title:
Phone No.:
*
Extension:
Contact Email Address:
*
Single email address that representing your business
Confirm Email Address:
*
Please confirm the email address
I acknowledge that my registration is NOT complete until I return to the VRS profile and complete all tabs and upload our company's W9.
Create Account
Cancel
1800 N.W. 49th Street Suite 120 • Fort Lauderdale, FL 33309 • (954) 473-7289 • Developed By P&D © 2021