Reinstatement Request Form

Reinstatement Request Form
* Indicates the field is required

Company Name:

Company eVA Customer Number:

Optional

Company DUNS Number:

*
Click here to find your DUNS Number

Last 4 Digits of Tax ID Number:

Please enter a value for the field Title.

Your Name:

Your Title:

Telephone Number:

*
Example: (XXX-XXX-XXXX)

Please enter a value for the field Phone.

Ext.:

Optional

Your Email Address:

Verify Email Address:

Billing Address Line 1:

Please enter a value for the field Your Name.

Billing Address Line 2:

City:

State:

Zip:

Do you accept the Terms and Conditions::

Terms and Conditions:

1. You certify that you have the authority to bind the above-named company
to these Terms and Conditions.

2. You agree, or reaffirm your prior agreement, to the current eVA Vendor
Registration Memorandum of Agreement posted on the eVA website under
the link labeled "Billing & Payment Portal. "Or Click Here"

3.You agree to pay all past-due, current and future eVA vendor
registration and order transaction fees upon receipt of an invoice issued by
the Commonwealth of Virginia, Department of General Services.

Note: A copy of the eVA Fee Schedule is posted on the eVA website under
the link labeled "Billing & Payment Portal". "Or Click Here"

Your request to reinstate your eVA Vendor Registration Account will be
processed within three (3) working days after the eVA Billing Customer Care
Team verifies your eVA Billing Account has a $0.00 balance or that
payment arrangements have been made for remittance of any previously
unpaid eVA fees. If you have questions regarding your eVA Billing Account,
call 1-866-289-7367 and select OPTION 2.

Submit