Phone: 620-235-4155 Fax: 620-235-4166
Use your cursor to highlight this form. Press CTRL-C to COPY it. Open your email program and with the cursor in the body section, press CTRL-V to PASTE it into your email message. Then add your info at the end of each line. In the Subject line of the email, please indicate your Commodity/Service. When finished, email to Brad Stefanoni.
COMPANY NAME: FEDERAL IDENTIFICATION NUMBER: ADDRESS #1: ADDRESS #2: CITY: ST: ZIP: TOLL FREE TELEPHONE NUMBER: TELEPHONE NUMBER: CELL PHONE NUMBER: FAX NUMBER: CONTACT NAME: EMAIL ADDRESS: WEBSITE LINK: COMMODITY/SERVICE PROVIDED BY VENDOR: OTHER INFORMATION: