Raceway Fleet Card Application

1 Raceway Fleet card Application Mail or fax it to: Raceway Fleet card Program 1411 Stelton Road Piscataway, NJ 08854 Fax # 732-572-9715 For more information call 732-819-9116 APPLICANT- Please read the following before completing this form: (1) A representative of the company authorized to enter into contractual agreements must sign this Application . (2) The Personal guaranty section must be completed and signed by an authorized officer of the company. (3) PLEASE READ AND SIGN BELOW BEFORE SUBMITTING THIS Application . Business Name: How long in business? Years Nature of Business _____ Type of Business: Partnership Corp. Sole Proprietor Federal Tax ID# Street Address: Address City State Zip Billing Address: Address City State Zip Phone Number Dun and Bradstreet Duns # Fleet Account Contact.

2 Contact Name Title Phone Number Fax Number Email Address Total Number of Cards Requested Estimated Monthly Usage $ Bank Reference: Bank Name Address City State Zip Contact Phone # Account# Trade References.

3 Company Contact Phone Number Company Contact Phone Number Company Contact Phone Number PERSONAL guaranty INFORMATION Last Name Initial first Name Home Address: Address City State Zip Home Phone Birth Date Social Security Number E-mail Address (optional) By providing my e-mail address, I consent to receive e-mail communications about my account.

4 PERSONAL guaranty In consideration of the seller financing purchases under the Raceway Commercial Charge Account Agreement, the undersigned hereby agrees to unconditionally, absolutely and irrevocably personally guarantee payment of all amounts due under, and performance under the terms of, the Agreement, and further agrees to pay the total balance due on the account opened pursuant to the agreement upon demand, without requiring Raceway Petroleum, Inc., or any assignee hereof, to proceed first to enforce payment against the buyer also liable on this account, in the event any default under the Agreement that governs the account. The buyer agrees to be responsible for any legal fees associated with collecting any amounts due on the account.

5 The undersigned hereby waives any notices regarding the Agreement or this guaranty , and agrees that this guaranty shall be applicable until after the Agreement has terminated and all amounts due there under shall have been paid in full. The undersigned guarantor agrees that in the event the account has not been paid as agreed, Raceway Petroleum, Inc. may report the undersigned's liability for and the status of the account to credit bureaus and others who may lawfully receive such information. Personal credit history of the undersigned guarantor will be used in making a credit decision and the undersigned guarantor authorizes Raceway Petroleum, Inc. to obtain a consumer report from a credit bureau. Direct inquiries of employers and businesses where the undersigned guarantor maintains accounts may also be made.

6 Undersigned Guarantor must be an authorized officer of the company. X_____ _____ PERSONAL GUARANTOR DATE NOTICE TO BUYER: (1) By signing below on behalf of your business, you represent that your business is a valid business entity; and that you are an authorized representative of the business with the authority to enter into contractual agreements. On behalf of the business, you certify that all information provided in the Application is complete and accurate. You agree to be bound by the terms of the governing credit agreement of the type elected in this Application and subsequently for purposes of updates, renewals or extensions of credit granted as a result of this Application or in receiving or collecting the Account.

7 You also understand that credit on this Account, once approved, will be extended by Raceway Petroleum, Inc., and that there is no binding contract between us until Raceway Petroleum, Inc. approves and accepts this Agreement. X_____ _____ SIGNATURE DATE _____ _____ PRINT NAME TITLE GENERAL TERMS AND CONDITIONS All accounts will be billed on a semi-monthly basis. Billing periods will be from the 1st to the 15th and the 16th to the last day of the month. Bills will be sent on the first business day following the end of the billing cycle. Payments are to be received within 15 days from date of Invoice. A Monthly Late Payment Charge of will be assessed if payment in full is not received within 30 days of Invoice date.

8 Monthly Accounting Fee of one half of one percent of total purchases will be assessed. Raceway Fleet card DRIVER PROFILE The Raceway Fleet card offers you the option to assign each card to a specific driver, vehicle or both. In addition, you also have the flexibility to assign specific charging privileges to each individual card . Authorizations Driver (Last Name, first ) Driver ID (if applicable) Vehicle ID (if applicable) Fuel Type Motor Fluids Store ItemsDays of Week Please attach additional sheet if more cards are needed. AUTHORIZATIONS Fuel Types: Applies to the grades of fuel that your drivers are authorized to purchase A = All Fuels, U = Unleaded Gas Only, D = Diesel Fuel Only Motor Fluids: Consists of all vehicle related fluids (Motor Oil, Brake, Steering, Transmission, DFS, etc.)

9 Y = Yes, N = No Store Items: Consist of any items sold in our convenience stores. (Snacks, Drinks, Tobacco, Maps, etc.) Y = Yes, N = No Days of Week: Applies to the days of the week that the drivers are authorized to use the Fleet card A = All Days of the Week, MF = Monday to Friday Only, WE = Weekends Only _____ I do not wish to assign my cards to a driver or a vehicle at this time. NOTE: If you elect to not assign your Fleet Cards at this time, the cards that you receive will be authorized to purchase all fuel types, motor fluids and store items on any day of the week. X_____ _____ SIGNATURE DATE _____ _____ PRINT NAME TITLE