Online Forms

All information is required unless marked optional.

Ship To / Delivery Information

Ship To / Delivery Name

Address

City

State / Province

Zip / Postal Code

Country

Phone Number

FAX (optional)


Bill To Information

Billing Name

Address

City

State / Province

Zip / Postal Code

Country

Phone Number

FAX (optional)

Purchase Order (PO#)


Contact Information

Contact Name

Email

Phone Number

FAX (optional)


Order Information

A minimum 72 hour lead time is necessary to schedule the shipment of bulk products.

A minimum 7-10 working days lead time is necessary for all packaged products.

Requested Ship / Delivery Date and Time

 
Pickup Delivery 

Carrier (if delivery)

Special Instructions (optional)


Product Information

Product 1:
Product 2:
Product 3:
Product 4:
Product 5:
Product 6:
Product 7:
Product 8:
Product 9:
Product 10:

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Your order will be submitted to our Order Processing department. A Mississippi Lime CSR will contact you soon.

All information is required unless marked optional.

Company Information

Business Name

Email

Address

City

State / Province

Zip / Postal Code

Country

Phone Number

FAX (optional)

Accounts Payable Manager

Federal ID or Social Security Number

Corporation Partnership Sole Proprietorship LLC Limited Partnership 

Division of (optional)

Subsidiary of (optional)

Date Business Started

Amount of Credit required for 30 day period:


Trade References

Trade #1 Name

Account Number (optional)

Address

City

State / Province

Zip / Postal Code

Country

Phone Number

FAX (optional)


Trade #2 Name

Account Number (optional)

Address

City

State / Province

Zip / Postal Code

Country

Phone Number

FAX (optional)


Trade #3 Name

Account Number (optional)

Address

City

State / Province

Zip / Postal Code

Country

Phone Number

FAX (optional)


Bank Reference

Bank Name

Account Number (optional)

Address

City

State / Province

Zip / Postal Code

Country

Phone Number

FAX (optional)

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Credit Policy

PAYMENT TERMS: As stated on invoice with approved credit, Cash in Advance without approved credit.

CREDIT TERMS: If credit is granted (I) (we) promise to pay all invoices when rendered. (I) (We) understand all invoices are payable within stated terms on invoice, after invoice date and agree to pay a service charge of 1 1/2% per month on (my) (our) past due account balance. In the event payment is not received and (my) (our) account is placed for collection, (I) (we) will pay all cost of collection. If legal action is required, (I) (we) will pay reasonable attorney’s fees and court costs resulting from such action. Past due accounts will be placed on hold for any future charges. The undersigned further agrees to immediately notify Mississippi Lime Company in writing by registered mail of any change in ownership or form of applicant’s business organization. The undersigned agrees to provide to creditor updated financial information on request, and to provide an annual financial statement to Mississippi Lime Company as a condition of the continuation of this extension of credit.

ARBITRATION: All controversies or claims arising out of or relating to this Credit Application or the goods or products or the contract between Mississippi Lime Company and you shall be settled by arbitration in accordance with the commercial arbitration rules of the American Arbitration Association. The parties may obtain discovery as provided in the Missouri civil court rules or any successor rules. The arbitration hearing shall be held in St. Louis, Missouri. The award shall be final, and judgment thereon may be entered in any court, state or federal, having jurisdiction. The arbitrator shall have no power to impose punitive or exemplary damages. The arbitrator shall apply Missouri law in rendering any decision.

GOVERNING LAWS: The laws of the State of Missouri (without regard to its choice of law principles) shall govern the dealings between the parties, including the construction of these terms. The state and federal courts located within the Federal District for the Eastern District of the State of Missouri shall have the exclusive jurisdiction of any action between them, and you agree to submit to the jurisdiction of such court.

CERTIFICATION AND AUTHORIZATION TO RELEASE INFORMATION: I hereby certify the information in this credit application is correct. The information included in this application is for the use of Mississippi Lime Company in determining the amount and condition of credit to be extended. I understand that Mississippi Lime Company may also utilize other sources of credit information which it considers reliable in making this determination. Further, I hereby authorize the bank and supplier references listed in the credit application to release the information necessary to assist Mississippi Lime Company in establishing a line of credit, or updating my existing file.

All fields are required unless marked optional. Please allow 5-7 business days to process sample request.

Contact Name

Work Number

Email


Business Name

Address

City

State / Province

Zip / Postal Code

Country


Requested Product

Requested Size

Company UPS or FedEx Account #
(Calcium Oxide products can ship by Air (FedEx only) but with restrictions.)

Application

Comments (optional)

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Thank you for your interest in Mississippi Lime Company. We appreciate the opportunity to review your company and products.

Please complete the following vendor questionnaire. Photos, catalogs, samples, and other information can be mailed to the address below or emailed to purchasing@mississippilime.com.

Purchasing Department
Mississippi Lime Company
16147 U.S. Highway 61
Ste. Genevieve, MO 63670

All fields are required unless marked optional.

Contact Name

Email

Work Number

Cell Number (optional)


Business Name

Address

City

State / Province

Zip / Postal Code

Country


Product Detail

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All fields are required.

Your Name

Your Email

Requested Certificate

Your Message

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