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.
DISCLAIMER OF ALL WARRANTIES
MIDLAND SERVICE, INC. MAKES NO WARRANTY OF ITS PRODUCT, EXPRESS OR IMPLIED, INCLUDING MERCHANTABILITY AND FITNESS FOR A SPECIFIC PURPOSE
Products and Services Needed notice to Married Applicants: No provision of any marital property agreement unilateral statement under §706.59 Wis. Stats. or court degree under §766.70 adversely affects the interest of the creditor unless the creditor, prior to the time the credit is granted or an open-end credit plan is entered into, is furnished a copy of the agreement, statement or decree or has actual knowledge of the adverse provision. For Married Wisconsin Resident: If I am married a Wisconsin resident, and applying for an individual account, I agree that credit extended under this account if granted will be incurred in the interest of my marriage or family.
All fields marked with * are required fields. You will be unable to submit the form until all required fields are complete.
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.
TERMS AND CHARGE ACCOUNT AGREEMENT
Please select "Yes" or "No" for each product option.
CHARGE ACCOUNT AGREEMENT
I agree that the following terms will govern any purchases made which are charged to my account that I may have with you:
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.
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 P.O. Box 500, Ashland, Wisconsin 54806. Write to us as soon as possible. We must hear from you no later than 60 days after we sent you the first bill on which the error or problem appeared. You can telephone us, but in doing so will not preserve your rights.
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. Your 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.
By selecting "Yes", typing my name in the "Applicant Sign" box, and clicking the "Submit" button, I acknowledge that I have read, understand and accept the terms of the Credit Application and Agreements contained on this page.
FOR INDIVIDUALS OR SOLE PROPRIETERS
Midland Services, Inc
An Energy Company