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Search for:
e-zpass
About E-ZPass
Purchase an E-ZPass
Activate your E-ZPass
tolls
Toll Calculator
Pay Unpaid Toll
Dispute a Toll Amount
travel info
Travel Advisories
Road Projects
Lane Closure Report
Travel Plazas &
Commuter Parking
Military Convoys
Emergency Info
File a Claim
commercial drivers
Travel Information
Dimensions &
Weight Limits
Lane Widths
Special Hauling Permits
Search for:
Home
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Doing Business with ITRCC
>
Create Supplier Account
Create an Account
Create Supplier Account
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Next Steps: Install the User Registration Add-On
This form requires the Gravity Forms User Registration Add-On. Important: Delete this tip before you publish the form.
Name
(Required)
First Name
Last Name
Email
(Required)
Enter Email
Confirm Email
Username
(Required)
Password
(Required)
Enter Password
Confirm Password
Company Information
Company Name
(Required)
Address
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Main Contact
(Required)
First Name
Last Name
Phone
(Required)
Email
(Required)
Does your company have an address or point of contact different from the corporate address that needs to be shown on purchase orders, contracts, or payment remittance purposes?
Yes
No
Address
(Required)
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Main Contact
(Required)
First
Last
Phone
(Required)
Email
(Required)
Does your company have a point of contact different from the main contact above for contract compliance reasons?
Yes
No
Name
(Required)
First
Last
Phone
(Required)
Email
(Required)
Business Status
Is your company a Certified Woman, Minority, Veteran Small Business or Disadvantaged Business? If yes to any, please attach a copy of your certificate(s). Check all that apply.
(Required)
No, does not qualify
No, but interested to see if my business qualifies
Yes
IDOA WBE
IDOA MBE
IDOA IVOSB
National or Other XBE
Enter Certifying Agency and Type:
Attache a copy of your certificate(s)
Drop files here or
Select files
Max. file size: 1 GB.
Does your company have a DE&I (Diversity, Equity, and Inclusion) Program that includes Supplier Diversity reporting?
Yes
No
I do not know
Are you interested in learning more about developing a supplier diversity program?
Yes
No
Payment Information
Do you offer Net45 payment terms?
(Required)
Yes
No
Do you offer early-pay discounts?
(Required)
Yes
No
Does your company accept payment by MasterCard credit card?
(Required)
Yes
No
File Drop / Upload
Please upload your completed W9 or W8 and any other pertinent documents (certifications, line card/capability statement, ACH payment instructions, location listing).
Drop files here or
Select files
Accepted file types: jpg, jpeg, pdf, gif, png, Max. file size: 256 MB.
Additional Information
Areas of Work Interest
Check all that apply
Local to my city only
From IL border to Elkhart
From Elkhart to OH border
All of road
Does your company provide Business Industry Codes?
Check all that apply
Goods only
Goods and Services
Professional Services only
Construction and/or INDOT Highway Construction Services
Please provide your work industry codes in relation to working with the ITR. We accept both NAICS and UNSPSC codes.
Visit
NAICS
and
UNSPSC
for more details.
Is your company able to provide COI's and bonding documentation?
Yes
No
Does your company have a written Safety Plan in place?
Yes
No
Are you able to provide your written Safety Plan for work relating to facilities and/or the roadway along the ITR corridor?
Yes
No
Is your company prequalified for INDOT (Indiana Department of Transportation) work/contracts?
Yes
No
Please list any NAICS or major/minor INDOT prequal work codes below.
Link for
INDOT Prequal codes
please provide/attach any supporting documentation.
Drop files here or
Select files
Accepted file types: jpg, jpeg, pdf, gif, png, Max. file size: 256 MB.
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