Membership Application Download Application PDF Step 1 of 4 25% I am a(n):* Business Individual Name*Company NameAddress*City*State*Zip Code*PhoneCellFaxEmail Tax ID #*Number of Years in BusinessAverage Weekly Fuel Bill $*Are You A Bulk Customer? Yes No A bulk customer is any company that will have 7500 or more delivered gallons. Credit References1. Company NamePhoneAddressBank References1. Company NamePhoneAddress Fuel CardsHow Many Vehicles Will You Be Registering?Odometer reading feature? Yes No Membership AgreementPlease accept my application into full membership of the Great Northern Cooperative. I hereby agree with the terms disclosed in the Articles of Incorporation and Bylaws of the Co-op, now and hereafter in effect, copies of which are available upon request. Upon approval of the application, I will agree to pay the annual membership fee of $45 and that I have signed the Membership Agreement. After my membership shall have been in effect for 1 year from the date of the signed Agreement, either party may terminate it by notifying the other party in writing of this intention. If neither of the parties of this agreement so notifies the other, it is mutually agreed that this shall constitute conclusive evidence that the parties have renewed this agreement for another year and will be automatically billed. I authorize the references listed above as well as any other creditors or credit bureaus to release credit information on any of my accounts.Consent* I have read and accept the terms and conditions.*Signature*By typing in this box you agree your electronic signature is the legal equivalent of your manual signature.Date MM slash DD slash YYYY Please enter your payment details. By entering your credit card or ACH details here, you consent to a $45 charge for your first year of membership, and subsequent $45 charges each anniversary for the duration of your membership.How do you want to pay? Credit/Debit Card Bank Payment CAPTCHAPhoneThis field is for validation purposes and should be left unchanged.