APPLICATION FOR CREDIT. CREDIT REFERENCES **Do not list banks, credit cards, phone companies as they will not provide credit information

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1 2801 3rd St., Tillamook, OR Phone (503) Fax (503) APPLICATION FOR CREDIT Business Account Company President/Owner_ Account Contact_ Billing Address Street/Delivery Address City, State, Zip Phone Cell Fax EIN Years In Business Personal Account Bill To Account Contact Billing Address Street/Delivery Address City, State, Zip Phone Cell Fax Employer How Long SSN Applying For (check all that apply): Ο Shell Station Charge Cards Ο Delivery Ο CFN Cards Types Of Fuels Used: Ο Gasoline Ο Diesel Ο PUC Diesel Ο Off-Highway Diesel Heating Oil: Tank Size? Ο Furnace Oil Ο Stove Oil Ο Keep Full Ο Will Call CREDIT REFERENCES **Do not list banks, credit cards, phone companies as they will not provide credit information Name Address Account Number Phone Fax Name Address Account Number Phone Fax Name Address Account Number Phone Fax If you do not have local credit references, we will accept your credit report. You can access your free credit report by going online to

2 PLEASE LIST ANY REPOSSESSIONS, GARNISHMENTS, SMALL CLAIMS, OR COLLECTION ACTION TAKEN AGAINST YOU. INCLUDE NAME, ADDRESS, AND PHONE NUMBER OF PERSON TAKING THE ACTION AND DATES ACTION TAKEN COLLECTION COST AND ATTORNEY FEES IF THIS ACCOUNT IS PLACED IN THE HANDS OF AN ATTORNEY DUE TO A DEFAULT IN THE PAYMENT OR PERFORMANCE OF ANY TERMS OF THE CREDIT AREEMENT, THE CUSTOMER SHALL PAY, IMMEDIATELY UPON DEMAND, SHELDON OIL COMPANY S REASONABLE ATTORNEY FEES, AND COLLECTION COST, EVEN THOUGH NO SUIT OR ACTION IS FILED, AND ANY OTHER REASONABLE FEES OR EXPENSES INCURRED. IF ANY SUIT OR ACTION IS INSTUTUTED TO ENFORCE ANY OF THE TERMS OF THIS ACCOUNT THE PARTY NOT PREVAILING SHALL PAY THE PREVAILING PARTY WHAT THE COURT MAY DETERMINE TO BE REASONABLE FOR THE PREVAILING PARTY S ATTORNEY FEE FOR TRIAL OR ANY APPEAL OR BY PETTION FOR REVIEW. SHELDON OIL COMPANY TERMS ACCOUNTS ARE DUE AND PAYABLE, IN FULL, ON THE 10 TH OF THE MONTH FOLLOWING EACH BILLING PERIOD. CARDLOCK ACCOUNTS ARE SUBJECT TO INVALIDATION OF ALL CARDS IF ACCOUNT BECOMES PAST DUE. ALL ACCOUNTS BALANCES NOT PAID WITHIN 10 DAYS WILL ACCRUE INTEREST AT 18 % PER YEAR (1.5% PER MONTH) ON THE UNPAID BALANCES UNTIL FULLY PAID. I, THE ABOVE NAMED APPLICANT, HAVE READ, UNDERSTOOD, AND ACCEPT THE COLLECTION COSTS AND ATTORNEY FEES, AND SHELDON OIL COMPANY TERMS. SIGNATURE: DATE PHONE-HOME: WORK:

3 CREDIT INFORMATION RELEASE AUTHORIZATION Date: To: _ In accordance with Federal Regulation known as the Safeguard Rule (16 CFR (b)) this is to authorize you, and at my direct request, to furnish Sheldon Oil Company, Inc. with any and all credit information concerning my account. I contemplate doing business with Sheldon Oil Company, Inc. and want them to have all the information there is available on my firm or me as an individual. Therefore, I would appreciate your complying with Sheldon Oil Company Inc. s request for credit information concerning me as an individual or the firm I am connected with, which is: Name: Address: City: State: Zip: Sincerely, Print Name Title Signature Address City, State, Zip Code Telephone Date Signed

4 CERTIFICATION OF OREGON USE FUEL TAX EXEMPT STATUS ( Use Fuel = Diesel, Propane, CNG or other fuel that is not gasoline) We hereby request to purchase Use Fuel Exempt of Oregon Use Fuel tax as permitted by ORS for the following reasons: (Check all that are applicable) 1) Vehicle displays a valid ODOT Motor Carrier Transportation Division permit (P.U.C. permit) or pass: 2) Vehicle displays a valid Use Fuel vehicle emblem issued by the ODOT Fuels Tax Group Please list Permit, Pass or Emblem numbers from 1) or 2) above:(attach extra sheets if necessary) 3) Vehicle displays a United States Government License Plate or is a vehicle owned by a state agency or local governmental entity and displays a State of Oregon E-Plate. 4) Vehicle is a farm tractor or other agricultural implement only incidentally operated on the highway as defined in ORS (7); 5) Vehicle is used exclusively on privately owned property and is not operated on Oregon highways. STATEMENT OF CERTIFICATION We hereby certify that all Use Fuel purchased ex tax at non-retail facilities in Oregon on our account with Sheldon Oil Company, Inc. (seller) will only be used for Use Fuel tax-exempt purposes as defined in ORS through We further agree that we are responsible for proper reporting and payment of taxes, plus applicable interest at 12% per annum and penalties of up to 35% of unpaid taxes, due the State of Oregon for Use Fuel purchases tax-exempt on this account and used for non-exempt purposes. We further agree that this tax reporting and payment responsibility extends to purchases of Use Fuel made using any additional or replacement non-retail cards issued under this account. We therefore indemnify and hold harmless Sheldon Oil Company, Inc. (seller) and its subsidiaries and assigns from any and all liability relating to the improper use of tax exempt cards. Purchaser: Company Name: Account #: Address: City: State: Zip: Signed by: Date: Print Name: Title: Seller: Sheldon Oil Company, Inc.

5 OREGON EXEMPTION CERTIFICATE -- CARD AND VEHICLE LIST CUSTOMER: ACCOUNT NUMBER: IN THE VEHICLE IDENTIFIER, LIST THE FOLLOWING INFORMATION BASED ON THE REASON FOR EXEMPTION: Exempt '1' List MCTD Weight Receipt Number Exempt '2' List Make and Model of vehicle and FTG Emblem number Exempt '3' List Government Plate Number Exempt '4' List Make and Model of Farm-use Equipment or Tractor Exempt '5' List Make and Model of Unlicensed Vehicle or Equipment Fleet ID (optional) VEHICLE/EQUIPMENT IDENTIFIER (see above) Cardlock Card Number Assigned State Tax Status Exempt Taxed CUSTOMER SIGNATURE DATE This worksheet is provided as a guideline for customers and card issuers when setting up accounts. A computer generated list containing the same information on vehicles and cards is also acceptable.

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7 2801 Third Street Tillamook, OR Phone: (503) FAX: (503) WRITTEN AGREEMENT FOR COMMERCIAL (NON-RETAIL) FUEL DISPENSING In order to comply with Oregon Revised Statutes (ORS to ) and Oregon Administrative Rules (OAR to ), all Oregon Cardlock/Keylock customers must meet and agree to the criteria listed below. Read each portion of this agreement carefully before signing. Company or Business Name: Address: Federal ID Number: Phone Number: If a Federal Identification Number is not available, attach copies of other current documentation such as: a business license, a contractor s license, a federal tax Schedule C or Schedule F, or other documentation issued by a governmental agency that clearly shows you are a business enterprise, government agency, or a nonprofit or charitable organization. 1. I agree to purchase a minimum of 2,400 gallons of Class 1 flammable liquids or diesel fuel from any source during each 12 month period. After January 1, 2002, I agree to purchase a minimum of 900 gallons of Class 1 flammable liquids or diesel fuel from any source during each 12 month period, or: (check if one applies) I will provide annual documentation that the fuel qualifies as a deductible farming expense on my federal income tax return. The fuel will be purchased by a government agency providing fire, ambulance, or police services. I was a customer of the non-retail facility on and since June 30, 1991, and meet all other criteria. 2. I agree to provide a Federal Employer Identification Number or copies of equivalent documentation as noted above to indicate participation in a business, government agency, nonprofit or charitable organization identified herein. 3. I agree to dispense Class 1 flammable liquids only into containers or into the tank of motor vehicles that are OWNED AND USED by the business, government agency, nonprofit or charitable organization identified herein. After January 1, 2002, I agree to dispense Class 1 flammable liquids only into containers or into the tank of motor vehicles that are OWNED OR USED by the business, government agency, nonprofit or charitable organization identified herein. I also agree that NO PERSONAL USE is allowed, and I understand that I am subject to a citation for violating this agreement. 4. I certify that each person, including all employees, allowed to dispense Class 1 flammable liquids for my account have received the safety training as required by the State Fire Marshal before dispensing any fuel. By signing this agreement, I certify that all information provided and agreed to is true and correct. Typed or Printed Name: Signature: Date: Falsely certifying that you are qualified as a non-retail fuel customer or that the above information is true and correct, when it is not, can lead to criminal prosecution under ORS

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