Submitted by Stiroh Lang on Tue, 01/15/2019 - 2:56pm If you wish to pay by check, fill out this form and submit it. You will then get an option to print it. Mail the printed version with your check.Make checks payable to: University of WashingtonTax ID #: 91-6001537 Course or Live Event Your First Name * Your Last Name * Your Email Address * Your Phone Number * Please include area code. Name of Company * Division or Department Company Address * (City, ST, Zip) Keywords that describe your company's products or services * Exhibitor Fees * Non-profit Agency - $250 For-profit Agency - $500 Payment Type * Check Budget Number (HMC, UW only) (Please type your budget name and number in the payment comment area below.) Purchase Order (Please provide PO# and contact information in the payment comment area below.) Payment Comments * Please list your payment details here, such as budget number, PO number, etc. If the check will be issued by a company other than the name listed above, please indicate what company will be listed on the check, so we may match payment to your order. Names of representative(s) who will staff your exhibit Leave this field blank
