Credit Application and Participation Agreement

Legal Business Name *

Email *

Street Address *


  

Mailing Address (if different than street address)


  

Estimated Annual Sales *

Accounts Payable Contact *

Estimated Credit Required *

Number of Employees *

How Long in Business *

Type of Business *

Average Weekly Fuel Usage *

Type of Company:

Fill up the one that applies

Sole Proprietorship
    

Partnership
    

Federal Tax No. *

State Tax ID *

Sales Tax Exemption *
YesNo

* If Yes, certificate will be required

Bank *

Branch *

Phone Number *
  

Fax *
  

Street Address *


  

Officer Contact *

Account No. *

Type of Account *

I hereby authorize the bank named above to release information requested for the purpose of obtaining and/or reviewing credit.

*All the following fields are mandatory

Document three references:

Reference 1: *
           

Reference 2: *
           

Reference 3: *
           

The preceding information is for the purpose of obtaining credit and is warranted to be true. I/We hereby authorize Patriot Fuels LLC to investigate all references and customary credit information sources including consumer credit reporting repositories regarding my/our credit and financial responsibility for the purpose of obtaining credit and for periodic review for the purpose of maintaining the credit relationship.

ACH POLICY: ACH payment must be made from invoices generated during the previous 7 calendar days. All ACH draws shall be made on the first business day, not withstanding holidays, of each week. Termination of ACH transactions and credit may be placed on any past due account, at the Company’s sole right and discretion.

CREDIT POLICY: Customer shall receive a thorough credit review whereby credit terms and limits shall be placed upon each account. As a history of successful transactions occurs, we will visit expanding credit limits on a case by case basis.

VENUE: It is agreed that this agreement is entered into in the state of Illinois and is governed by the laws of the state of Illinois.

CHANGE OF OWNERSHIP: I/We understand that we must notify Patriot Fuels LLC in writing and by certified mail of any change in ownership, the name of the business or structure of the business under which credit is established.

In the event of default, and if this account is turned over to an agency and/or an attorney for collection, the undersigned agrees to pay all reasonable attorney fees, court costs, bond costs, and/or costs of collection whether or not suit is filed.

I/We certify that this request is for the extension of credit for business purposes only and not for the extension of credit for personal, family, or household purposes.

Firm Name *

Signature *

Date *

Print Name *

Date *

The undersigned individual who is either a principal of the credit applicant or a sole proprietorship of the credit applicant, recognizing that his or her individual credit history may be a factor in the evaluation of the credit history of the applicant, hereby consents to and authorizes the use of a consumer credit report on the undersigned by the above named business credit grantor, from time to time as may be needed, in the credit evaluation process.

Signature *

Date *

Print Name *

For valuable consideration, the receipt of which is acknowledged, including but not limited to the extension of credit by Patriot Fuels, LLC to:

the undersigned, individually, jointly and severally, unconditionally guarantee(s) to Patriot Fuels, LLC the full and prompt payment by:

of all obligations which Guarantor presently or hereafter may have to Patriot Fuels, LLC and payment when due of all sums presently or hereafter owing by Guarantor to Patriot Fuels, LLC Guarantor agrees to indemnify Patriot Fuels, LLC against any losses Patriot Fuels, LLC may sustain and expenses Patriot Fuels, LLC may incur as a result of any failure of Guarantor to perform including reasonable attorneys’ fees and all costs and other expenses incurred in collecting or compromising any indebtedness of debtor guaranteed here under or in enforcing this guaranty against guarantor. This shall be a continuing Guaranty. Diligence, Demand, Protest or notice of any kind is waived. It shall remain in full force until guarantor delivers to Patriot Fuels, LLC written notice of revoking it as to indebtedness incurred subsequent to such delivery. Such delivery shall not affect any of guarantors obligations hereunder with respect to indebtedness heretofore incurred.

The undersigned personal guarantor, recognizing that his or her individual credit history may be a necessary factor in evaluation of this personal guarantee, hereby consents to and authorizes the use of a consumer credit report on the undersigned, by the above named business credit grantor, from time to time as may be needed, in the credit evaluation process.

Signature *

Date *

Print Name *

Signature *

Date *

Print Name *

Witness *

Date *

Witness Print Name *

Please type security code: