Application for Cash Account
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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?
If so when?
Under what name?
Do you want your Bank Card information kept on file?
Are you Tax Exempt?
If you answered Yes to Tax Exempt, please fill out the Tax Form under the New Customer Tab on the Main Website
Would you like to be set up with Online Shopper?
If you answered Yes to Online Shopper, please fill out an ID/Password no more than 8 Characters long.
Online Shopper Login
Online Shopper Password
Please List People Authorized to Use this Account
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