Group Medical Vendor Application (RTF)
Healthcare organizations seeking registration for the organization and not for individuals of the organization.
Employment Services Contract Application
At this time we are not accepting new applications for Employment Services Providers. If you are interested in becoming an ES provider, please contact firstname.lastname@example.org with your contact information, and we will contact you once the application process is reopened on June 1, 2017.
ORIGINAL FORM MUST BE MAILED (address included on form) to the Department of Financial Services (DFS). DFS will not accept this form via fax or email. It must be mailed and include the ORIGINAL signature. Forms received by Vendor Registration WILL NOT BE FORWARDED. Please follow the directions of this form in order to ensure that this request is completed.
* Requires background screening
** Some service provider types require background screening
Go to Background Screening web page for information on requirements.
Additional Information and Forms
VR Provider Manual DRAFT (PDF)
This is a draft of the new VR Provider Marnual. If you are a current VR Provider, please review the document and give us your feedback by May, 5, 2017 at www.surveymonkey.com/r/XMY6YKV. We welcome your input.