MID-SOUTH POWER DISTRIBUTORS, INC.
ACCOUNT SET-UP FORM

Thank you for your interest in Mid-South Power Distributors. To open a COD Account, please complete the information on this page. Also, if we should not charge sales tax on your purchases, please attach legal proof of Tax Exemption such as a certificate of resale, industrial machinery certificate etc.

Enter the Names of Officers, Partners, Principals or Proprietors as appropriate:



***THIS APPLICATION MUST BE SIGNED BEFORE PROCESSING CAN BEGIN***
Signature of Authorized Individual *
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3250 MILLBRANCH -- MEMPHIS, TN 38116 -- PHONE: 901-396-0710 -- FAX: 800-552-3280