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

     
    PickupDelivery

    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

      CorporationPartnershipSole ProprietorshipLLCLimited 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

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      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.

        Please allow 2 weeks to process sample requests. If you have any questions regarding your sample request after submission, feel free to contact sample@mlc.com.

        *All fields are required.

        Requestor Information

        Business Name

        Contact Name

        Work Number

        Email


        Receiver Information

        Is the Receiver the same contact as the Requestor above?     Yes   No

        Business Name

        Contact name

        Address

        City

        State / Province

        Zip / Postal Code

        Country


        Select Products

        Select Products for Samples
        QuicklimeHydrated LimePrecipitated Calcium CarbonatePulverized QuicklimeGround Calcium Carbonate

        Quicklime
        Pebble Quicklime 2 inPebble Quicklime 1 inPebble Quicklime 1/2 inGranular Quicklime

        Hydrated Lime
        Standard HydrateHydrate SPHydrate FGTActivated HydrateHydrate HRLiquid Calcium Hydroxide 38% solidsMicroCal HFMicroCal HFT20MicroCal HSMicroCal HXPPetroCal HFPetroCal HSVitaCal HVitaCal LCHPetroCal HStoverCal HType S Standard HydrateType N Standard Hydrate

        Precipitated Calcium Carbonate
        Magnum Gloss 72% SlurryMagnum Gloss SATMagnum Gloss SD PCCMagnum Gloss XFMagnum Fill 65% PCCMagnum Fill 70% PCCMagnum Fill SDMagnum Fill MMagnum Fill SDLMagnum Fill HO97VitaCal PCC

        Pulverized Quicklime
        Pulverized Quicklime FTMicroCal OF 100MicroCal OF 200MicroCal OF 325MicroCal OFT15MicroCal OXPPolyCal OF 325PolyCal OS 325PolyCal OFT15VitaCal OPetroCal OF 100PetroCal OS 100

        Ground Calcium Carbonate
        CalCarb R1CalCarb R2CalCarb Mineral FillerCalCarb Coal Mine Rock DustCalCarb Athletic Field MarkerCalCarb Ag Stone A1CalCarb Ag Stone A2CalCarb AC3CalCarb PG (Poultry Grit)FGD LimestoneFeed Grade Limestone

        Requested Size - Quicklime: Pebble Quicklime 2 in

        Requested Size - Quicklime: Pebble Quicklime 1 in

        Requested Size - Quicklime: Pebble Quicklime 1/2 in

        Requested Size - Quicklime: Granular Quicklime

        Requested Size - Hydrated Lime: Standard Hydrate

        Requested Size - Hydrated Lime: Hydrate SP

        Requested Size - Hydrated Lime: Hydrate FGT

        Requested Size - Hydrated Lime: Activated Hydrate

        Requested Size - Hydrated Lime: Hydrate HR

        Requested Size - Hydrated Lime: Liquid Calcium Hydroxide 38% Solids

        Requested Size - Hydrated Lime: MicroCal HF

        Requested Size - Hydrated Lime: MicroCal HFT20

        Requested Size - Hydrated Lime: MicroCal HS

        Requested Size - Hydrated Lime: MicroCal HXP

        Requested Size - Hydrated Lime: PetroCal HF

        Requested Size - Hydrated Lime: PetroCal HS

        Requested Size - Hydrated Lime: VitaCal H

        Requested Size - Hydrated Lime: VitaCal LCH

        Requested Size - Hydrated Lime: PetroCal H

        Requested Size - Hydrated Lime: StoverCal H

        Requested Size - Type S Standard Hydrate

        Requested Size - Type N Standard Hydrate

        Requested Size - Precipitated Calcium Carbonate: Magnum Gloss 72% Slurry

        Requested Size - Precipitated Calcium Carbonate: Magnum Gloss SAT

        Requested Size - Precipitated Calcium Carbonate: Magnum Gloss SD PCC

        Requested Size - Precipitated Calcium Carbonate: Magnum Gloss XF

        Requested Size - Precipitated Calcium Carbonate: Magnum Fill 65% PCC

        Requested Size - Precipitated Calcium Carbonate: Magnum Fill 70% PCC

        Requested Size - Precipitated Calcium Carbonate: Magnum Fill SD

        Requested Size - Precipitated Calcium Carbonate: Magnum Fill M

        Requested Size - Precipitated Calcium Carbonate: Magnum Fill SDL

        Requested Size - Precipitated Calcium Carbonate: Magnum Fill HO97

        Requested Size - Precipitated Calcium Carbonate: VitaCal PCC

        Requested Size - Pulverized Quicklime: Pulverized Quicklime FT

        Requested Size - Pulverized Quicklime: MicroCal OF 100

        Requested Size - Pulverized Quicklime: MicroCal OF 200

        Requested Size - Pulverized Quicklime: MicroCal OF 325

        Requested Size - Pulverized Quicklime: MicroCal OFT15

        Requested Size - Pulverized Quicklime: MicroCal OXP

        Requested Size - Pulverized Quicklime: PolyCal OF 325

        Requested Size - Pulverized Quicklime: PolyCal OS 325

        Requested Size - Pulverized Quicklime: PolyCal OFT15

        Requested Size - Pulverized Quicklime: VitaCal O

        Requested Size - Pulverized Quicklime: PetroCal OF 100

        Requested Size - Pulverized Quicklime: PetroCal OS 100

        Requested Size - Ground Calcium Carbonate: CalCarb R1

        Requested Size - Ground Calcium Carbonate: CalCarb R2

        Requested Size - Ground Calcium Carbonate: CalCarb Mineral Filler

        Requested Size - Ground Calcium Carbonate: CalCarb Coal Mine Rock Dust

        Requested Size - Ground Calcium Carbonate: CalCarb Athletic Field Marker

        Requested Size - Ground Calcium Carbonate: CalCarb Ag Stone A1

        Requested Size - Ground Calcium Carbonate: CalCarb Ag Stone A2

        Requested Size - Ground Calcium Carbonate: CalCarb AC3

        Requested Size - Ground Calcium Carbonate: CalCarb PG (Poultry Grit)

        Requested Size - Ground Calcium Carbonate: FGD Limestone

        Requested Size - Ground Calcium Carbonate: Feed Grade Limestone


        Shipping Method and Billing

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

        Account Number

        Is this a third-party shipping account? Yes   No

        Please enter the owner's name or company name


        Application and Comments

        Application (Examples: cement additive, rubber compound filler, lubricant, etc.)

        Comments (optional)

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        If you have any questions regarding your sample request after submission, feel free to contact sample@mlc.com.

          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@mlc.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

            Your Phone Number

            Requested Certificate

            Your Message

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