414
Toll Free Phone
1-888-821-5725
www .mi d l and i ndu s t r i a l . com
M M
M
F
G
Legal Business Name
DBA:
Resale No.
Mailing Address
Street Address
City State
Zip
City
State Zip
(
Attach Certificate)
Name of Principal
Name of Principal
Name of Principal
Residence Address
Residence Address
Residence Address
City
City
City
State & Zip
State & Zip
State & Zip
Title & S/S No.
Title S/S No.
Title & S/S No.
Please place a check mark where appropriate:
( )
Corporation
( )
Partnership
Business premises:
( )
Proprietorship
( )
Owned
Value $_______________ Mortgage $_______________
( )
Rented
Lessor: _________________________________________
Founded _____/_____/_____ EIN ____________________ Annual sales $___________________
Fed ID#
Midland Metal Manufacturing Company
phone
888-821-5725
fax
888-877-5391
P.O. Box 415040
Kansas City, MO 64141-5040
CREDIT APPLICATION
(
Please type or print legibly)
( )
New Account
( )
Updated Information
Date: ______________________
Phone
Email
Fax
How did you hear about Midland: Referral Postcard Email Web Magazine
Other ______________________________
Do you except backorders?
YES
NO
Accounting Contact Informaiton
FAX
EMAIL
UPS Collect # (If Preffered)