Requester Information

Your First Name *

Your Last Name *

Your Email Address *

Building/Location *

Professional Services Agreement

This agreement is entered into the date listed below written between the Des Moines Public Schools (District) and (Provider):

Is the provider a current DMPS student? *

Is the provider a current DMPS employee? *

You state the provider is a current DMPS employee. Please carefully consider if this service creates a conflict of interest.

You state the provider is a current DMPS student. This is not the correct form. You will be directed to the Casual Labor form when you click the NEXT button.

Provider (Company) name: *

Primary Contact (First and last name)

PO Box

Provider Street Address *

Provider City *

Provider State *

Provider Zip Code *

Provider Email Address

Fax Number

Primary Phone Number

Cell Phone Number

Web Address

Is this a new provider? *

See attached memo for requesting a new Vendor CLICK HERE TO READ

Please fill out the New Vendor Form

Is this a....... *