Unclaimed Funds

Please complete the form to claim your funds associated with your Mirabito Energy Products account that is now inactive. New York State;s Abandoned Property Law requires businesses to notify customers of credit balances on any account that has not been active in the last three (3) years. If we do not hear from you within the 45 days of your notification letter, New York State law requires us to submit this property to the New York State Unclaimed Property Division. At that time, you will need to request your money through the State.
Please complete this form now to avoid delays in receiving your funds.

Please Complete This Form

Unclaimed Funds

Account Numer(Required)

Please enter your account number, as indicated on the letter you received.

Name(Required)

First Last

Current Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Unclaimed Funds Certification (choose one only)(Required)

I certify that the unclaimed funds are mine and I am entitled to the refund.

I do NOT certify that the unclaimed funds are mine and I am NOT entitled to the refund.