New Account Request

Mid-Western Research & Supply
430 N. Mosley
Wichita, KS 67202
Tel. 800-835-2832
Fax. 316-262-5136
E-mail

NEW ACCOUNT INFORMATION:

- To access our commercial online store we must set up an account for your company. Please fill out the following information or call us at 1-800-835-2832.

- Once you have filled out the form below, it will be reviewed by a salesman, and then you will be contacted with confirmation of your new account. Please allow a couple days for confirmation. Thank you.

Please Provide Your Information Below:
*User Name:
*Password:
*Confirm Password:
(password must be a minimum of 6 characters)
*Name:
Title:
*Company:
*Street Address:
Address (cont'd):
*City:
*State:
*Zip/Postal Code:
*Country:
*Work Phone:
Fax #:
*Federal Tax ID #:
E-Mail Address:
*Type of Business:
Billing Options:
(please check the billing option you would like to use)	Check One:
Purchase Order #:
Check By Phone:
Credit Card:
Comments:
*denotes a required field THANK YOU! WE LOOK FORWARD TO SERVING YOU. IF YOU HAVE QUESTIONS ABOUT THIS FORM PLEASE CALL US AT 1-800-835-2832.

Try our #1 selling Seasoning Shaker today!
Ultimate Steak & Roast Rub is great on steaks, hamburgers, roasts, other beef products, and even eggs, green beans, and much more!

We ship by UPS the same day you order as long as your items are in stock and you place your order before 5pm CST!
Need to track your shipment?
CLICK HERE TO TRACK YOUR PACKAGES.

Request a FREE home processors catalog. It contains everything you need to process meat from your home.