Midwest Petroleum is always looking for new and innovative products.  If you would like to submit a product for review, please complete the steps below.  All fields are required.  Due to the large number of inquiries received, incomplete applications will be not be processed.  (Note: If a particular field is not applicable, indicate "not applicable".  Do not any fields leave blank.)
 

Company Name:
Company Street Address:
City:
State:
Zip Code
Full Name of Representative:
Phone Number and Extension:
Fax Number:
Email Address:
   
Product Name:
Product Specs (Dimensions):
Number of Boxes Per Case:
Number of Selling Units Per Box:
Item Number:
Case UPC Number:
Box UPC Number:
Selling UPC Number:
   
List Wholesalers Currently Carrying This Product:  
Current Wholesaler # 1
Current Wholesaler # 2
Current Wholesaler # 3
   
List Customers Currently Carrying This Product:  
Current Customer # 1
Current Customer # 2
Current Customer # 3
   
Minimum Order Quantity/
Pricing Breakdown:
Slotting Fee?   (Choose Yes or No)
If yes, please provide details:
Rebate Program?   (Choose Yes or No)
If yes, please provide details:
Payment Terms:


Please check your typed entries above for accuracy before submitting.

 


 

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