Beacon Roofing Supply, Inc.

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Page 1 of 4* Application must be completed in full and signed by Corporate Officers, Partners, or Sole ProprietorC. COMMERCIAL TRADE REFERENCES NameCity and StateTelephone #Account BUSINESS INFORMATIONPartnershipPartnerDriver s Lic.#SS#Address:OwnRentHome #PartnerDriver s Lic.#SS#Address:OwnRentHome # s Lic.#SS#Address:OwnRentHome #V-P MemberDriver s Lic.#SS#Address:OwnRentHome #OwnerDriver s Lic.#SS#Address:OwnRentHome #ProprietorshipCorporationLLPLLCSec/Memb erDriver s Lic.#SS#Treas/MemberDriver s Lic.#SS#Sales ID: A. APPLICANT INFORMATIONBranch #:Full Legal Business Name:DBA Name:Mailing Address:Phone:Contractor / Business LLC#:Street Address:City:State:Zip:City:State:Zip:Ce ll: Fax:E-Mail Address:Date Business Started:Type of Business:Website Address:State of Incorporation:Tax Pay ID No.:Estimated Monthly Purchases? $Taxable? ( ) Yes ( ) No IF NO, attach copy of Tax Exemption or Resale CertificateAccounts Payable Contact:Name of Person to Contact in case of an Emergency:Authorized Buyers:PH:PO Required?

Page 3 of 4 1. It is agreed that the Applicant (including all subsidiaries, divisions and affiliates of) will pay all invoices and billing statements within the terms and conditions of all invoices supplied, with or without Applicant's signature, by any