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MUIR Energy Retail Account Application
Submit all completed questions and MUIR will contact you to get started.
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* Indicates required question
Company Name
*
Your answer
Website
*
Your answer
Shipping Address
*
Your answer
Store Phone Number
*
Your answer
Retail Tax ID#
*
Your answer
Buyer Full Name
*
Your answer
Buyer Email
*
Your answer
No Third- Party Sales
*
I understand that I am prohibited from advertising or selling Muir Energy through any third-party websites or platforms (Amazon, Ebay, Walmart, etc.) unless explicitly approved in writing.
Required
A/P Contact Info (Name, Email, Phone)
*
Your answer
Payment Method
*
* Terms Reserved for larger accounts- Accounts are Eligible for review after first 5 orders
Credit Card
Terms (First 5 orders will be placed on a Credit Card)
Required
How did you hear about us?
*
Google Search
Recent Event
Other:
Signature
*
Your answer
Date
*
MM
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DD
/
YYYY
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