Michlig Commercial Customer Form

New Commercial Customer Form

Please use this form to submit your request to become a new customer of Michlig Energy, Ltd. Complete the form as thoroughly as possible to help us complete your request in a timely manner.
Please note that all fields marked with an asterisk (*) are required.
Company Name*
Years in Business*
Federal Tax ID*
Is Your Company A Sole Proprietorship?*

YesNo
Are you Tax Exempt?*

YesNo
Company Mailing Address*

Street Address

Street Address Line 2

CityState

Zip Code
Delivery Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Fax Number*
Please enter a valid phone number.
Your E-Mail Address*
example@example.com
Products Needed*

Fuels (Diesels, Gases, Home Heat)PropaneLubricantsDEF
How Did You Hear About Us?

Michlig EmployeeFamily/FriendWebsiteAdvertisementOther
Bank / Credit Union*
Bank / Credit Union Phone Number*
(###) ###-####
Bank / Credit Union Contact Person*
Credit References

List obligations such as Finance Companies, Utility Companies, Etc.
Creditor
Credit Phone Number
Please enter a valid phone number.
Creditor City
Creditor
Creditor Phone Number
Please enter a valid phone number.
Creditor City
Creditor
Creditor Phone Number
Please enter a valid phone number.
Creditor City
Terms of Service

I agree that the following terms will govern any purchases made which are charged to any account that I may have with Michlig Energy, Ltd.
1. I will pay the entire balance according to my account terms. (Discounts may be offered on certain bulk product purchases bases on the marketing program.)
2. I understand that a FINANCE CHARGE of 1.50% (an annual rate of 18.0% per year) will be applied to that part of any balance not paid before the last billing day of the following month plus any previous balance that remained unpaid.
3. Payments shall be applied first to the unpaid FINANCE CHARGE, then to the remaining outstanding balance.
4. In the event that collection proceedings must be instituted to collect any balance due, I will be subject to a collection fee have up to 30% of the balance due and/or court costs.
5. If applying for a joint account, both of us agree to be bound by the terms of this agreement and each of us agree to be jointly and severely liable for payment of all purchases made.
6. Accounts that reach 60 days past due shall be deemed cash only. The company at its option may limit or terminate charge privileges at any time. I, the undersigned, agree to the terms of Michlig Energy, Ltd. credit policy. I request credit to be extended to me under these terms and agree to act and remit in accordance. I further understand that by signing this application, Michlig Energy, Ltd is not bound to extend credit. I authorize by my signature below, any employer, financial institution, or other creditors that may or may not appear on record to release information pertaining to my credit.
Your Signature

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Applicant Name*

First NameLast Name
Applicant Position*
Signature of Co-Applicant

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Co-Applicant Name*

First NameLast Name
Co-Applicant Position *
Please verify that you are human*
By submitting this form, I the undersigned, agrees to the terms of Michlig Energy, Ltd. credit policy. I request credit to be extended to me under these terms and agree to act and remit in accordance. I further understand that by signing this application, Michlig Energy, Ltd. is not bound to extend credit. I authorize by my signature above, any employer, financial institution, or other creditors that may or may not appear on record to release information pertaining to my credit.
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New Commercial Customer Form