Vendor Registration by Mail

• Read the following policies
  • Regulation of Vendor Representatives and the Vendor Liaison Office (pdf)
  • Control of Trial Supplies of Prescription Medication: Samples, Drug Vouchers & Starter Supplies (pdf)
• Complete and sign the Vendor Representative Registration Form
  • Vendor Registration Form (pdf)
  • Vendor Registration Form (doc)
• Complete and sign the Visiting Vendor Representative Confidentiality Agreement
  • Visiting Vendor Representative Confidentiality Agreement (pdf)
  • Visiting Vendor Representative Confidentiality Agreement (doc)
• Vendor representatives that request patient contact will need to submit documentation of the following:
  • Completion of the yearly UWHC Safety and Infection Control training. Vendor representatives will be required to complete the training and bring the printout of certification to the VLO at registration.
  • Vaccination against or documented immunity against measles, mumps, and rubella.
  • Vaccination against or documented immunity against varicella.
  • Vaccination against or documented immunity against Hepatitis B or completion of the 
  • A negative tuberculosis skin test or proof of being non-infectious.
• Clip a standard ID style photo to the first page of the registration. A passport style photo is preferred. Do not send copies of federal or state identification. Any registrations with unsuitable photos will not be processed.
• Clip a check for payment to the first page of the registration. The check must be made out for $200 to UWHCA (University of Wisconsin Hospital and Clinics Authority).
• Do not send credit card information through the mail.
• Send all materials to Vendor Liaison Office, 600 Highland Avenue, Mail code: 1639, Madison, WI  53792. 
• Allow 10 to 15 business days for process to be completed and badge to be mailed.