ellsworth

Residential Account Application:

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Name:
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Billing Address:
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Primary phone number:
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Secondary phone number:
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Date of birth:
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Employer:
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Employer's Address:
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Employer's phone number:
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Spouse:
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Spouse's date of birth
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Spouse's employer:
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Employer's address:
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Employer's phone number:
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Are you applying for an open credit account?
YES   NO

(By checking YES, you authorize Ellsworth Farmers Exchange to obtain additional information from credit bureaus and all other lawful sources regarding your credit history, and you certify that all information given on this form is true and accurate. Checking NO means your account will remain cash-on-delivery ONLY.)

 

ACCOUNT TERMS AND CONDITIONS

Payment is due within 30 days of invoice date on open accounts.

A finance charge of 1.5% per month (18% per year) will be added to all balances over 30 days.

Any open account that becomes more than 60 days past due will be placed on cash-on-delivery status and will be subject to collection efforts.

Customer will notify company of any address/phone number changes.

Discounts of $0.05 per gallon plus tax will be granted on home heating fuels if payment is received within 10 days of the delivery, provided your account balance is current.

If it becomes necessary for us to pursue legal action to collect a past due balance, customer will be responsible for paying all associated fees and costs, including reasonable attorney fees if applicable.

Minimum delivery is 150 gallons for refined fuels and propane, or $175 total order for feed and/or store merchandise deliveries.

Driveways must be clear of snow and other debris on delivery day. The EFE/EES is not responsible for any damages due to feed or fuel outages if delivery point is not accessible.

A delivery charge of $75 (during business hours) or $100 (after hours and weekends) will be collected for emergency fuel deliveries, deliveries requested on an alternate route day, or repeated delivery attempts due to customer negligence (drive not plowed, no money, etc.).

Propane tanks and regulators remain the sole property of Ellsworth Energy Services, division of the Ellsworth Farmers Exchange, and may be removed for failure to pay or if the equipment is tampered with.

Feed deliveries will be subject to a delivery charge for deliveries made on an alternate route day. Bulk feed and fertilizer deliveries are subject to our delivery charge schedule.
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I have read and agree to the terms and conditions above.
YES   NO

* Enter Your Email Address:

Type in the text that you see above:

  

Ellsworth Farmers Exchange
6509 Center St.
Ellsworth, MI 49729
Phone: 231.588.2300
Fax: 231.588.2106
contact@ellsworthco-op.com

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