NJ DDD Community Vendor Form

Hello NJ DDD Vendor:

Thank you for taking the time to submit the required information needed to complete the NJ DDD Community Vendor List. This list will be beneficial for the families we serve. Please include all required information requested on the form below no later than Friday, May 10, 2024.

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* 1. Vendor Name:

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* 2. PONJD#: (only enter the Unique six-digit number assigned by PPL at the time of enrollment)

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* 3. Complete Mailing Address

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* 4. Email Address

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* 5. Vendor Phone #

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* 6. Services Offered (please check all that apply):

Assistive Technology - Evaluation (T2028HI)

Assistive Technology - Purchase/Customize/Repair/Replace/Train (T2028HI22)

Assistive Technology - Remote Monitoring (T2029HI)

Environmental Modification (S5165HI)

Natural Supports Training (S5110HI)

Transportation – Single Passenger (A0090HI)

Vehicle Modification (T2039HI)

Goods and Services (T1999HI22)

Goods & Services – Classes

Goods & Services – Dance classes

Goods & Services – Art classes

Goods & Services – Equine therapy

Goods & Services – Gym/Fitness Center Membership

Goods & Services – Swim classes

Goods & Services – Music classes

Goods & Services – Durable Medical Equipment

By clicking Submit, you agree to include the above information in the PPL Community Vendor List and acknowledge the list will be included on the PPL website found here njddd_communityvendorlist.