Vendor Approval Form

Thank you for your interest in becoming an approved vendor, allowing you to visit Activity Centers and engage with older adult participants.

Fill out the Vendor Approval Form and submit.
Within one week, Sixty and Better Operations Department will review your request and follow up with you.
If approved, you will be able to contact Activity Center Directors to schedule opportunities for you to provide support.

Please note, approved vendors are NOT ALLOWED to do the following in Activity Centers:

Sell any product or services
Gather any participant information, such as name, phone, email, address, social security numbers, etc.
Perform any tests or diagnostics

Primary Contact Information

First Name *This question is required.

Last Name *This question is required.

Organization *This question is required.

Title *This question is required.

Email *This question is required. This question requires a valid email address.

Primary Phone *This question is required.

Alternative Phone

Best Time to Contact You *This question is required.

Organization Website

Organization Facebook Page (if applicable)

Additional Organization Website or Social Media (if applicable)

Do you have regional oversight or authority for your organization? *This question is required.

Please provide the name and contact information for a regional or area manager/director.

First Name

Last Name

Title

Email This question requires a valid email address.

Phone

What is your reason for becoming an Approved Vendor? *This question is required.

What do you plan to do with older adult participants at Activity Centers? *This question is required.

Is your organization interested in becoming a sponsor of Sixty and Better events, programs, and/or activities? *This question is required.