Ellsworth Farmers Exchange Home Locations Services Market Center Weather About Us Forms Make a Payment Contact Account Access Residential Account Application Residential Account Application 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, including a $25 service fee if past due goes to our collection agency. 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. All court proceedings will occur exclusively in Antrim County's 86th District Court. Name First Last Billing Address* Street Address City Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Armed Forces Americas Armed Forces Europe Armed Forces Pacific State ZIP Code Primary Phone Secondary Phone Email* Date of Birth* Social Security #* Employer Employer Address Employer Phone Number Spouse's Name First Last Spouse's Date of Birth Spouse's SS# (if applying for joint credit) Spouse's Employer Spouse's Employer Address Spouse's Employer Phone Number Are you applying for credit? - 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. If you check NO or do not check either box, your account will remain cash-on-delivery. PLEASE NOTE: Scheduled Delivery and Automatic Credit Card Billing programs require credit approval.** 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. If you check NO or do not check either box, your account will remain cash-on-delivery. PLEASE NOTE: Scheduled Delivery and Automatic Credit Card Billing programs require credit approval. Date MM slash DD slash YYYY Customer Login Contact Us 877-885-0095 contact@ellsworthco-op.com Main Office & Ellsworth Energy Services, LLC 6509 Center St. PO Box 98 Ellsworth, MI 49729 Contact Us 877-885-0095 contact@ellsworthco-op.com Main Office & Ellsworth Energy Services, LLC 6509 Center St. Ellsworth, MI 49729 Home Make a Payment Locations Forms Contact Us Please Note: This web site contains links to other sites: Please be aware that we are not responsible for the content or privacy practices of such other sites. We encourage our users to be aware when they leave our site and to read the privacy statements of any other site that collects personally identifiable information. Copyright © 2021 Ellsworth Farmers Exchange. All rights reserved. Theme Spacious by ThemeGrill. Powered by: WordPress.