Application to Enroll in "Buy Missouri"

Application for the "Buy Missouri" Retail Partnership

For enrollment (upon approval) in the Buy Missouri online retail directory prepared by the Office of Lieutenant Governor, State of Missouri*. You may complete this application and click on the "Submit" button below to email it to our office. Thank you.
All applications will be subject to review and approval by the Buy Missouri Partnership.

*Parameters are subject to change.
Note: Do not use the Enter/Return key on your keyboard when filling out this application. We recommend that you use the Tab key when moving from line to line.

* Indicates required information
Business Name*
Business Address*

Street Address

Street Address Line 2

CityCounty

Postal / Zip Code
Description of Business*
Number of Missouri Employees*
State of Missouri Tax ID Number*
The Missouri state tax ID # is used solely for state tax reporting. The number will be an 8 digit number that is issued to you by the Missouri Department of Revenue to file your business taxes. No spaces.
Does your business sell products that are grown, manufactured or produced in the State of Missouri?*

YesNo
If so, what Missouri-made products do you sell, and who are they grown, manufactured or produced by?*
Required to sell at least a minimum of 5 Missouri-made products.
Would you like to be provided with Buy Missouri retail shelf tags, as shown below, to place next to your Missouri-made products?*

YesNo
Is your business in good standing with the State of Missouri?*

YesNo
Is your business veteran-owned?*

YesNo
Contact Information
Contact Name*

First NameLast Name
Contact Position*
Company Phone*

Area CodePhone Number
Other Phone

Area CodePhone Number
Email*
example@example.com
Website Address
Facebook Page Name
Twitter Handle
Instagram Handle
* By submitting this information, you acknowledge that it becomes a public record under Chapter 610 of the Missouri Revised Statutes. Likewise, the information provided will be used solely for the purpose of economic development to create and update a "Buy Missouri" online directory. The information you provide will not be sold or distributed for commercial use.

Products and services listed on this website do not constitute an endorsement or recommendation by the Office of Lieutenant Governor of the State of Missouri. Furthermore, the directory listing of the products or services on this website may not be used in advertising or for endorsement purposes.
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Application for the "Buy Missouri" Retail Partnership

Contact Information