APPLICATION FOR CREDIT

(1)

APPLICATION FOR CREDIT

DATE:

Companies

Please Check All That You Are Applying For:

CREDIT LINE REQUESTED: $

□

Bulk Fuel & Lubricants

□

FleetWide/CFN Card Lock

Are you a member of CDTOA: Y/N

(Circle one)

PART 1: COMPANY / INDIVIDUAL INFORMATION Company Or Individuals Name

Resale #

Street Address City State Zip Phone: Fax:

Billing Address City State Zip Phone: Fax:

Job Address/Delivery Address City State Zip Phone: Fax:

Business Is A:

Sole Proprietor Partnership Corporation Date of Corporation: State of Corporation:

Type of Business: SIC Code: Year Established: Contractor License Number Fed. Tax ID Number Accounts Payable Contact : Purchasing Contact:

Phone: Phone: Fax: Fax: E-Mail: E-Mail:

Employer / Broker: Address: Phone: Contact: Drivers License Number State Expiration Date Date of Birth: Name and Address of

Nearest Relative: Phone: Have you ever filed bankruptcy ? Yes Business

Date Filed: No Personal Chapter : 7, 11, 13, Other. (circle one)

PART II: LIST NAME(S) OF OWNER(S) PARTNER(S) CORPORATE OFFICER(S) SHARE HOLDER(S)

Position Name Home Address City/State/Zip Social Security / Phone

SS#: Phone: SS#: Phone: SS#: Phone: PART III : REFERENCES

Bank Address / City / State / Zip Account Number

Trade (active) Address / City / State / Zip Account Number

Fuel Supplier (past & present) Address / City / State / Zip Account Number

FOR OFFICE USE ONLY

(2)

CREDIT TERMS AND CREDIT AGREEMENT

The undersigned agrees to the following terms in all transactions with The Goodspeed Companies unless otherwise agreed to in writing by authorized Company officer of The Goodspeed Companies.

PAYMENT TERMS

Bulk Motor Fuel Products (commercial) Net 15 Days From Invoice Date

Bulk Motor Fuel Products (resale) C.O.D. or Electronic Funds Transfer (4 DAYS) Card Lock (Billed Semi Monthly) Net 15 Days From Invoice Date

Lubricants, Greases, Specialty Products: Net 30 Days From Invoice Date

The undersigned hereby applies to The Goodspeed Companies for credit and it is understood that all billings from The Goodspeed Companies are fully due and payable within our credit terms as stated above. Failure to pay the full amount due under any billing within said credit terms shall be grounds for immediate revocation, without notice, of all credit privileges extended by this agreement, and the undersigned further agrees that in the event any amount remains unpaid after stated credit terms, such amount shall be subject to interest/service charge equal to 18% per year of the outstanding balance until paid. The undersigned further agrees to pay reasonable attorney’s fees and costs as incurred by The Goodspeed Companies in the event services of attorney are required in any manner for collection of any past due balance. The undersigned further agrees any such collection activities will be brought and tried in the San Bernardino Superior Court, Victorville California District.

ADDITIONAL CARD LOCK CREDIT AGREEMENT

♦ Goodspeed Auto-Fuel Systems, Inc. reserves the right to discontinue credit to any account without notice when it is considered to be in the best interest of the Company and you agree to surrender all G.A.S. Inc. cards on demand.

♦ Customer acknowledges by signature that the process of issuing card lock network fueling access cards is a process separate and distinct from the process of issuing credit to the business.

♦ If a card is lost, stolen, or misplaced, promptly notify the company by calling (760) 947-7540 and then FORWARDING WRITTEN NOTICE.

By signing, Customer acknowledges that it will be liable for all charges made with a lost, stolen, or

misplaced card until Company has

RECEIVED WRITTEN NOTICE

.

For the protection of your account, we strongly recommend that security codes not be written on or kept with card or their protective envelope.

♦ Customer acknowledges by signing that card lock network fueling access cards are being issued to a business, not a natural person, and that cards are to be used for the limited purpose of activating card lock network automated fueling dispensers for that business and recording the time, place, date, gallonage, and cost of the fuel dispensed so that the transaction can be completed by issuance of an invoice to the business at a later date.

♦ Customer accepts any and all liability arising or resulting from or related to the use, misuse, unauthorized use, loss or theft of any

Goodspeed Auto-Fuel Systems, Inc. card resulting in access to a Goodspeed Auto-Fuel Systems, Inc. facility or other facility that accepts a Goodspeed Auto-Fuel Systems, Inc. Fleetcard or any affiliated fueling network. Customer understands that the rights conferred herein allow Customer access to purchase products.

♦ Customer acknowledges and accepts that a UCC-1 filing to secure debt may be filed upon credit approval.

♦

_{The price posted and/or on printed receipt at any CFN/Fleetwide or any affiliated fueling facility location are not for CFN/Fleetwide}

transactions. Your price is negotiated between you and Goodspeed Auto-Fuel Systems, Inc.

♦ For Card Lock Accounts there is a one-time non-refundable set-up fee of $ 25.00 per account.

♦ A $2.00 per card re-activation fee maybe charged for accounts locked out for credit purposes.

♦ Card Lock Accounts are subject to a 3% processing fee for payments made by credit card.

We hereby authorize you to release any and all credit, bank account and loan information that may be required for purposes of obtaining credit with The Goodspeed Companies

Please Print Name Signature Date

PERSONAL GUARANTY

In consideration of credit granted by The Goodspeed Companies the undersigned personally guarantees any and all charges and/or money due The Goodspeed Companies. This sum to include any and all attorney’s fees and collection costs. In the event payment is demanded by The Goodspeed Companies the undersigned agrees to make payment within 10 days. This is a continuing guaranty and shall remain in full force until revoked by the undersigned in writing to The Goodspeed Companies, but such revocation shall be effective only as to claims of The Goodspeed Companies which arise out of transactions entered into after its receipt of such notice. The undersigned further agrees any such collection activities will be brought and tried in the San Bernardino Superior Court, Victorville California District.

(3)

Auto-Fuel Systems, Inc.

CARDS REQUESTED---How Many? ________. Please use 1 line for each card requested

A.

NAME, VEHICLE #, OR VEHICLE MAKE * alpha / number ( 16 characters Max)

B.

VEHICLE NUMBER * 4 Digits ( numeric only)

C.

MAXIMUM GALLONS PER FILL-UP: Set to 40 gallons unless

otherwise noted

D.

NUMBER OF FILL-UPS PER DAY Set to 3 unless otherwise noted

B.

TYPE OF FUELS PURCHASED:

Set to A/F unless otherwise noted

E.

CUSTOM PIN (5 DIGITS)

Can’t start with 0, & can’t repeat in account

Set random unless otherwise noted

F. CUSTOM

E-RECIEPT, SINGLE-(S) VEHICLE-(V) DRIVER-(D)

* TYPE OF FUELS TO BE PURCHASED WITH CARD:

A/F = ALL FUELS , GAS = GAS ONLY, DSL = DIESEL ONLY –OR-

U = UNLEADED ,M = MID-GRADE ,P = PREMIUM ,DF = DIESEL ,BD = BIODIESEL ,RD = OFF ROAD RED DYED DIESEL

RED DYED DIESEL REQUIRES SEPARATE CARD

Every account can be customized,

if special requests please call directly to your Cardlock Salesperson: 760-559-0254

A: Name, Veh. # or Veh. Description – Card may be identified by vehicle #, user name or vehicle make.

B: Type of Fuels – Used to restrict card to a specific type of fuel or, All Fuels (A/F) for most flexibility.**

C: Maximum Gallons per fill up – This will restrict a per pump gallon limit.

D: Each card is set to a maximum of three (3) fill-up per day unless otherwise noted.

E. Custom pin – Optional, set to random pin unless otherwise noted.

F. OFFICE USE ONLY

(4)

CARD AUTORIZATION FORM

Customer/Account Name:_________________ Account #

The following person(s) have my authorization to make the indicated changes to the cards issued on my

Goodspeed Auto-Fuel Systems account.

New

Change

Replace

Mail/Pick up

Name (first & last)

New

Change

Replace

Mail/Pick up

Name (first & last)

New

Change

Replace

Mail/Pick up

Name (first & last)

New

Change

Replace

Mail/Pick up

Name (first & last)

New

Change

Replace

Mail/Pick up

Name (first & last)

NOTE: Due to the possibility of theft or loss, anyone can call and have the card initially locked out. However,

the terms of the application still apply as to written notice.

All cards that are mailed will be sent certified mail with a return receipt. In the instance of replacement cards no

pin code will be provided.

When a new card is issued or an existing card is changed, a new list of cards with information of limits,

products authorized and pin numbers will be generated only on request.

In the event there is a change in the person(s) authorized to make changes to the cards a new

Card Authorization Form must be submitted.

They can be requested through the Cardlock office by phone: 760-956-9538 or email :

[email protected]

I have read and agree to the above terms and authorizations.

___________ _

Please Print Name

Signature (must be same as on application)

Date

(5)

Distributing, Inc.

CALIFORNIA RE-SALE CERTIFICATE

Company Name:

Account Number:

Address: ____________________________________________________________________

I HEREBY CERTIFY: That I hold valid Seller’s Permit Number:

Issued pursuant to the Sales and Use Tax Law, that I am engaged in the business of selling:

, that the tangible personal property described herein which I shall purchase from: R.E. Goodspeed and Sons Distributing, Inc. 11211 “G” Street, Hesperia, CA. 92345. will be re-sold by me in the form of tangible personal property: provided, however, that in the event any such property is used for any purpose other than retention, demonstration, or display, while holding it for sale in the regular course of business, it is understood that I am required by the Sales and Use Tax Law to report and pay tax, measured by the purchase price of such property or other authorized amount.

Description of property to be purchased:

Signature of Purchaser or Authorized Agent Date Signed

Print or Type Name of Person Signing Verified By

Title of Person Signing Date Verified

(6)

Distributing, Inc

GASOLINE & DIESEL FUEL EXEMPTION CERTIFICATE

For State or Local Government, including public school and transit districts or other regional government.

Buyer:

Acct #

Address

:

City

:

Zip

:

GASOLINE FEDERAL TAX EXEMPTION CERTIFICATE

The undersigned buyer certifies that all gasoline purchased for the period JANUARY 1 THRU DECEMBER 1 20___ (period not to exceed 12 months), will be for the:

_______Exclusive use of a State or Local Government, including public school and transit districts or other regional government.

CLEAR DIESEL FEDERAL TAX EXEMPTION CERTIFICATE

The undersigned buyer certifies that all diesel fuel purchased for the period JANUARY 1 THRU DECEMBER 1 20___ (period not to exceed 12 months), will be used for the following tax exemption purposes:

_______ Exclusive use of a State or Local Government, including public school and transit districts or other regional government.

FEDERAL TAX ID:

PRINTED NAME OF SIGNER: SIGNATURE:

TITLE OF PERSON SIGNING:

TELEPHONE: DATE:

APPLICATION FOR CREDIT