BSI: Buyer Registration Form

If you have questions as to how to complete the form, click on the line item description to bring up helpful information. * Denotes a required field. If you have questions contact K. Baun at 608-240-5262 or L. Lipska at 608-240-5258
*Buyer ID: (10 character limit)
*Password:
*First and Last Name:
*Your Email Address:
*Your Phone Number:
*Your Authorizing Agent:
*Authorizing Agent Email:
Will you be using Purchase Orders?	Yes No
Blanket PO Number:
Blanket PO Expiration Date:
If you intend to use a Credit/Purchasing Card, enter the information here.
Are you authorized to purchase the parenting newsletter?	Yes No
Please enter in the text boxes below your Primary Billing Information and the one or more Shipping Addresses associated with that 'Bill to'.
*Primary Billing Information: Include Department Agency Name
*Primary Shipping Information: Include Department Agency Name
If you are purchasing for more than one Billing agency, again, enter the Billing Information and the one or more Shipping addresses associated with additional 'Bill to(s)'.
2nd Billing Information:
2nd Shipping Information:
3rd Billing Information:
3rd Shipping Information:
NOTE: By answering YES to the following questions, you are asking for the authority to enter Billing and/or Shipping Addresses, into an actual order, that have not been registered here today. this authority is subject to the approval of your authorizing agent
*Will your purchasing responsibilities require you to create new Shipping Addresses at time of ordering?	Yes No
*Will your purchasing responsibilities require you to create new Billing Information at the time of ordering?	Yes No

MDS Customer Id: