Application for Cash Account

Step 1: Resell/Exemption Cerfification.

In order for us to comply with the State of  Kansas Sales and Use Tax Laws, we are required to have a signed Resell/Used Certification on file.

Step 2: Submission of Application

By submitting the application you certify that you have the authority to submit this information and request an account for this company.

Billing Address for Bankcard.
Company Name *
PO Box
Street Name *
City *
Five Digit Zip Code and Four Digit Postal Code *
Phone Number *
Is this also your Shipping Address?
If no, fill in shipping address.
Company Name.
Owner's Name *
PO Box.
Street Name.
5 digit Zip Code dash (-) 4 Digit Postal Code.
Phone Number.
Fax Number
E-mail Address
Do you use P.O. numbers?
Do you have a CFC certification?
If yes please fill out our EPA/CFC Certificate under the New Customer Forms tab.
Do you have an account with us? Or have you had an account with us in the past?
Have you signed up for an online shopper account?
If so when?
Under what name?
Acct Number.
Do you want your Bank Card information kept on file?
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