Customer Application

Customer Application

  • Note: Affinity Energy requires that you provide an electronic copy of your company's W-9 form. Please attach one to this form where indicated.

  • Contact Information

  • Buyer Contact

  • Accounts Payable Contact

  • Bill To

  • Drop files here or
    Accepted file types: jpg, png, pdf, doc, docx.
    Max. upload size: 2MB.
  • Accepted file types: jpg, png, pdf, doc, docx.
    Max. upload size: 2MB.
  • Company Information

  • Officers, Partners or Owners



  • Company Description

  • Bank Reference

  • Trade References



  • This field is for validation purposes and should be left unchanged.