MIDLAND SERVICES, INC.
888-873-9527
FAX 715-682-6165
Credit Application
for Individuals or Sole Proprietors
Name 1 ____________________________________________________________________________
Name 2 ____________________________________________________________________________
(If
there is more than one applicant or joint with spouse)
Service Address______________________________________________________________________
MailingAddress ______________________________________________________________________
How long at present address _______________ Own _____ Rent _____
Home Phone ___________________ Fax _________________ Email __________________________
Previous Address ____________________________________________________________________
(If less than two years at present address)
Nearest relative not living with you _____________________________________________________
Address _______________________________________________________ Phone ______________
Landlords Name ________________________________________________ Phone ______________
Credit Information
APPLICANT NO. 1 APPLICANT NO. 2
|
|
|
|||||
|
|
|
|
|||||
Products and Services Needed
Diesel ___ Gasoline ___ L.P. ___ Fuel Oil ___ Credit Cards ___ How Many ___ |
|
|
|
|
|||
Everything that I have stated in this application is
correct to the best of my knowledge. I
understand that you will retain this application whether or not it is
approved. You are authorized to check my
credit and employment history and to answer questions about your credit
experience with me. I agree to pay extensions
of credit in accordance with the terms of the credit policies of Midland
Services, Inc according to the co-op's policy.
INDEMNIFICATION OF CO-OP FOR INQUIRING WITH
EMPLOYMENT / TRADE / CREDIT REFERENCES The applicant shall indemnify and hold the Co-op
harmless form any claims, damages, etc., brought by anyone including the cost
of legal defense, for making inquiry into and with any references furnished by
the applicant. The applicant also hereby
grants permission to any reference above named to answer any questions posed to
it by the Co-op, and the applicant shall indemnify and hold that reference
harmless to the same extent as the applicant indemnifies and hold the Co-op
harmless. The Co-op shall also be held
harmless from the receipt and use of credit reports about the applicant or the
applicant's guarantor
MIDLAND SERVICES, INC.
P.O.
I
agree that the following terms will govern any purchases made which are charged
to my account that I may have with you:
1.
Each billing period,
a.
I will pay the entire amount of each invoice within 35 days of the
invoice date; or
b.
I will pay the deferred payment price for each purchase, consisting of
the cash price and a FINANCE CHARGE.
c.
Unpaid balances WILL ACCRUE a finance charge on day 36 after invoice
date with interest accruing from the date of invoice.
d.
The FINANCE CHARGE will be computed upon the unpaid balance of the
invoice, calculated on a daily basis after first deducting all payments,
credits, and refunds.
2.
The Finance Charge shall be determined by applying a periodic rate of
.0493% per day (ANNUAL PERCENTAGE RATE OF 18%) to the unpaid balance. Minimum of $.10 on past due balance less than
$10.00
3.
I have the option to pay my entire balance in full at any time without
incurring a subsequent a FINANCE CHARGE.
4.
If I default by failing to pay when due on two occasions within any
twelve month period, and I do not cure the default as permitted me by law, my
entire balance may, at your option, become due and payable. Your waiver of any default shall not operate
as a waiver of any other default.
5.
Each payment shall be applied: First to the unpaid FINANCE CHARGE;
then, as to the merchandise and services purchased on the same date, the lowest
priced shall be deemed first paid.
6.
I f the account is not paid according to policy; you may be required to
pay cash for purchases thereafter. In
addition, the Co-op reserves the right to place any account holder on immediate
COD anytime the Co-op has reasonable belief that repayment will not be made in
accordance with the credit policy, or if the Co-op does not want to extend
credit for any reason that is not otherwise lawful. However, special credit arrangements can be
made with the credit manager’s approval.
7.
Part of Midland Services’ earnings is distributed to qualifying patrons
in the form of equities, which are eventually revolved according to policies
established by the Board Of Directors. The Co-op’s Articles of Incorporation give
the Co-op a first lien on any equities you earn from patronizing the
Co-op. The Co-op routinely offsets those
equities against accounts that it considers uncollectible. The Co-op reserves the right to discount your
equities if it exercises its right of offset.
If you do not keep the Co-op informed of address changes, your allocated
equity, if any, will be deemed contributed to the Co-op’s unallocated surplus.
8.
The Co-op is not in the business of providing financing to its
customers. The Co-op provides
convenience credit according to the above policies. The Co-op may, but is not obligated to
continue extending credit to those who do not pay their account in accordance
with the Co-op’s credit policy. The
seller may change its credit terms relating to open-end accounts, pursuant to
the provisions of the Wisconsin Consumer Act.
9.
OTHER CHARGES: A $25.00 charge
is assessed for checks that are returned for non-sufficient funds. Midland Services is also permitted to recover
its attorney fees and other costs associated with collecting amounts owed Midland
Services.
YOUR BILLING RIGHTS UNDER THE
FAIR CREDIT BILLING ACT
This notice contains important information about
your rights and our responsibilities under the Fair Credit Billing Act.
1.
Notify Us In Case of Errors or Questions About Your Bill.
If you think your bill is wrong, or if you need more
information about a transaction on your bill, write us (on a separate sheet) at
In your letter, give us the following information:
(1) Your name and account number (2) The dollar amount of the suspected error
and (3) Describe the error, the dollar amount of the suspected error, and
explain, if you can, why you believe there is an
error. If you need more information,
describe item you are not sure about.
2.
You’re Rights and Our Responsibilities After
We Receive Your Written Notice.
We must acknowledge your letter within 30 days,
unless we have corrected the error by then.
Within 90 days, we must either correct the error or explain why we
believe the bill was correct.
After we receive your letter, we cannot try to
collect any amount you question, or report you as delinquent. We can continue to bill you for the amount
you question, including finance charges, and we can apply any
unpaid amount against your credit limit.
You do not have to pay any questioned amount while we are investigating,
but you are still obligated to pay the parts of your bill that are not in
question.
If we find that we made a mistake on your bill, you
will not have to pay any finance charges related to any
questioned amount. If we didn’t make a
mistake, you may have to pay finance charges, and
you will have to make up any missed payments on the questioned amount. In either case, we will send you a statement
of the amount you owe and the date that it is due.
If you fail to pay the amount that we think you owe,
we may report you as delinquent.
However, if our explanation does not satisfy you and you write to us
within 10 days telling us that you still refuse to pay, we must tell anyone we
report you to that you have a question about your bill. And, we must tell you the name of anyone we
reported you to. We must tell anyone we
report you to that the matter has been settled between us when it finally is.
If we don’t follow these rules, we can’t collect the
first $50. of the questioned amount, even if your bill
was correct.
DISCLAIMER OF ALL WARRANTIES
MIDLAND SERVICE, INC. MAKES
NO WARRANTY OF ITS PRODUCT, EXPRESS OR IMPLIED, INCLUDING MERCHANTABILITY AND
FITNESS FOR A SPECIFIC PURPOSE
Dated _____________ Signature _______________________________________________________
Dated _____________ Signature _______________________________________________________