E&I Contract Member Application | E&I Cooperative Services

Institution Information

Institution Name *

EIN/TIN *

Address *

ZIP *

City *

State *

Website Address *

Affiliation *

Institution Term *

2 year

4 year

K-12

N/A

Non-Profit *

Yes

No

Full Time Equivalent(FTE)

Number of Students(Numeric Only). This is required if you choose “Higher Ed” or “K-12” for Institution Classification

Institution Classification *

If you choose either “Higher Ed” or “K-12”, you must enter Full Time Equivalent(FTE).

Institution Type *

SIC Code *

Numeric Only

Contact Information

First Name *

Last Name *

Title *

Department Name *

Accreditation(s)

CPPO

CPM

APP

CPPB

Phone *

Email Address *

Referral Information

How did you hear about us?

Please specify

* The above Applicant institution hereby applies for Contract Patron membership with E&I Cooperative Services, Inc. (“E&I”) under the terms and conditions indicated herein, and, if accepted, agrees to abide by the terms and conditions in the By-Laws of E&I. The By-Laws will be forwarded under separate cover, or you may access them at membership@eandi.org.

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