CHENEY BROTHERS, INC. NEW ACCOUNT / CREDIT APPLICATION FORM

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1 CHENEY BROTHERS, INC. NEW ACCOUNT / CREDIT APPLICATION FORM S H I P T O Corporation Name Trade Name (d/b/a) B I L L Name Address Address Street City County State Zip City County State Zip T Phone No O ( ) Phone No Fax No ( ) ( ) Fax No Attention of ( ) address BUSINESS FACTS Proprietorship Corporation Partnership Other Type of Business Establishment Restaurant Seating Capacity In Plant Facility Franchise Hospital No. of beds School Other Nursing Home No. of beds Hotel Motel Length of time in business Previous location At present location DELIVERY INFORMATION Primary Delivery Day Desired (circle one) M T W TH F Primary Delivery Day Time Window (Minimum 4 Hour Window) Secondary Afternoon Delivery Time Window Option Hours of Operation: Open Close ACCOUNTING INFORMATION Purchase Order Required Yes/No Accounts Payable Contact Phone No. ( ) BUILDING/FACILITIES Owned Leased TO TO Name of Mortgagor Address Name of Lessor Address State Zip City State Zip Phone No. ( ) Phone No. ( ) Complete the following information for all corporate officers, partners, or an individual proprietor (add additional sheets if necessary) Name and Title Home Address City /State/Zip Name and Title Home Address City /State/Zip Home Phone No. Business Phone No. Home Phone No. Business Phone No. Social Security No. Date of Birth Social Security No. Date of Birth Drivers License No.(copy of DL or Photo ID required) Drivers License No. (copy of DL or Photo ID required) (Revised 2018)

2 CHENEY BROTHERS, INC. NEW ACCOUNT / CREDIT APPLICATION FORM * incomplete application may not be processed BANKING 1. Name 2. Name City City Account # Account # Phone # Phone # Person to Contact Person to Contact TRADE REFERENCES (Preferably Food Distributors) 1. Name 4. Name Phone # Phone # 2. Name 5. Name Phone # Phone # 3. Name 6. Name Phone # Phone # TERMS AND CONDITIONS Parties hereby agree that all purchases made are subject to the following terms and conditions: 1. The undersigned Purchaser hereby agrees that all amounts due for goods and services purchased from Cheney Bros., Inc. d/b/a Cheney Brothers, Inc. ( Cheney Brothers ) are payable at the address shown on the invoice and statement. In the event of any change in Purchaser name, location, authorized agents, or ownership, Cheney Brothers must be notified in writing. Any change may require a new New Account and Credit Application. Failure to do so will result in prior owners remaining jointly and severally liable for any new ownership or unauthorized debts. 2. The undersigned Purchaser hereby agrees that all amounts due Cheney Brothers are payable seven (7) days from the date of statement, unless the invoice or statement provides otherwise. If any amount due Cheney Brothers is not paid within said period, a delinquency charge in the amount of 1 1/2% per month, or any higher amount as permitted by Florida law, on the unpaid balance, shall be added to the total amount due. Additionally, any attorneys fees and costs, including but not limited to costs and fees of inhouse counsel or outside counsel, incurred in connection with efforts to collect any sums due, shall be added to the total amount due. Any attorneys fees and costs shall include costs and attorneys fees pre-litigation, at the trial level, on appeal, or in any bankruptcy or other proceeding. Purchaser agrees and acknowledges that any delay by Cheney Brothers in demanding payment or its acceptance of any partial payment shall not be deemed a waiver of any of Cheney Brothers rights. Venue for all actions arising out of or relating to this credit application or the transactions contemplated herein shall be exclusively in Palm Beach County, Florida. All transactions and agreements between the parties shall be governed by and interpreted in accordance with the laws of the State of Florida without regard to conflicts of law. Purchaser and Guarantor submit to personal jurisdiction in the State of Florida with respect to any and all matters arising out of or relating to this application and any dealings with Cheney Brothers. 3. The undersigned Purchaser agrees, pursuant to Florida Statute, Section , to pay Cheney Brothers the greater of (a) 5% of the face value of the check or other payment instrument which is protested, returned, deemed worthless, or otherwise dishonored due to a lack of funds, lack of credit, lack of an account, or which is stopped; or (b) the service charges specified in Florida Statute, Section (2). Additionally, Purchaser agrees to pay the above sum(s) plus three (3) times the amount of the face value of the check or payment instrument along with any court or other costs and reasonable attorneys fees, including but not limited to inhouse attorneys fees, in any action or efforts to recover the sums set forth herein. 4. The undersigned Purchaser agrees to pay in accordance herewith. In the event that a guarantee is executed, then all so executing shall be jointly and severally liable with each other and the Purchaser and relevant words herein shall be read as if referring to both the Purchaser and the Guarantor(s) in the plural. 5. The parties hereby acknowledge that the goods and/or services purchased from Cheney Brothers are not payable in installments, but are payable in full as stated herein. Ownership of the goods and services does not transfer to Purchaser until paid in full, unless otherwise stated. At any time prior thereto, Cheney Brothers reserves the right to confiscate such goods or cease such services in the event Purchaser fails to meet its payment obligations. Unless otherwise agreed in writing, any products or equipment leased or loaned to Purchaser must be returned within seventy-two (72) hours or Purchaser will be billed for cost of same at the full retail price of said products or equipment. Purchaser acknowledges that the goods and products purchased from Cheney Brothers may be subject to the Perishable Agricultural Commodities Act and that Cheney Brothers shall be entitled to all rights associated therewith, including, without limitation, status as a priority creditor in any relevant proceeding. ONE CHENEY WAY RIVIERA BEACH, FL W.P.B : WATS: FAX: CreditApplicationsRVB@CheneyBrothers.com 2801 W. SILVER SPRINGS BLVD. OCALA, FL OCALA: WATS: FAX: CreditApplicationsOCL@CheneyBrothers.com ONE CHENEY WAY PUNTA GORDA, FL PHONE: FAX: CreditApplicationsPUN@CheneyBrothers.com 3500 OLD BATTLEGROUND ROAD GREENSBORO, NC OFFICE FAX CreditApplicationsNC@CheneyBrothers.com (Revised 2018)

3 CHENEY BROTHERS, INC. NEW ACCOUNT / CREDIT APPLICATION FORM * incomplete application may not be processed 6. The undersigned Purchaser and Guarantor(s) hereby authorize(s) you to verify the information on this form, which is being requested by Cheney Brothers to establish credit with it. Specific Authorization is given to both the bank and trade references listed to disclose all account information for the specified accounts. Cheney Brothers is further authorized to conduct a credit check through Equifax or other credit-reporting agency on the Purchaser, Guarantor(s) and each individual officer, owners, partner or proprietor identified herein. Each such individual/party agrees to submit a copy of his/her driver s license or photo ID and any other identifying information requested as identification for this purpose. This form may be transmitted to any of the parties noted as proof of authorization. Cheney Brothers does not guarantee that Purchaser will be granted any terms of credit. Granting of credit terms, if any, is solely in Cheney Brothers discretion. 7. If purchase or payment is permitted to be made by credit card (requires separate authorization and form), Purchaser/cardholder waives all right to dispute or protest any and all such charges with its credit card company or bank. Charges, once made, are final and may only be disputed directly with Cheney Brothers Purchaser and Guarantor agree to provide supplemental credit information upon request. Unless otherwise agreed in writing, upon closure of account, payment of all outstanding balances is due within seventy-two (72) hours. Cheney Brothers may assign any and all of its rights and obligations herein to its affiliates as well as its successors and assigns. Purchaser may not assign any of its rights or obligations hereunder without written consent of Cheney Brothers. DEFINITION OF TERMS The undersigned hereby agrees that the definition of: Payment for all purchases made Monday through Saturday of any week is due no later than the Thursday of the Weekly Terms is: following week. Payment for all purchases made Monday through Saturday of any week is due no later than the Thursday of the Bi-Weekly Terms is: second week following the purchase. Payment for all purchases made Monday through Saturday of any week is due no later than the Thursday of the third 21 Day Term is: week following the purchase. Payment for all purchases made from the first of the month through the last day of the month are due no later than the Monthly Terms is: 10th of the next month. Date Sales Representative (Signature) Number X Officer, Owner or Partner (Signature) Sales Manager (Signature) Type or Print Name Title INDIVIDUAL PERSONAL GUARANTEE: I, (type or print name), residing at for and in consideration of your extending credit or approving opening of an account at my request to (Name of Company/ Purchaser ) of which I am hereby personally guarantee to Cheney Bros., Inc. d/b/a Cheney Brothers, Inc. ( Cheney Brothers ) of any obligation of the Purchaser and I hereby agree to bind myself to pay on demand any sum which may become due to Cheney Brothers, by the Purchaser whenever the Purchaser shall fail to pay the same in accordance with its terms. It is understood that this guarantee shall be a continuing and irrevocable indemnity for such indebtedness of the Purchaser. I do hereby waive notice of default, non-payment and notice thereof and consent to any modification or renewal of the credit agreement hereby guaranteed and to all renewals of extension of credit. This guarantee extends to all obligations of Purchaser, including but not limited to, Purchaser s obligation to pay service charges and potentially treble damages, attorneys fees and costs associated with any collection activities (either by referral to collection company or attorney or in-house attorneys fees and costs). GUARANTOR S SIGNATURE DATE WITNESS SIGNATURE DATE PLEASE OBTAIN A COPY OF RESALE CERTIFICATE ONE CHENEY WAY RIVIERA BEACH, FL W.P.B : WATS: FAX: CreditApplicationsRVB@CheneyBrothers.com 2801 W. SILVER SPRINGS BLVD. OCALA, FL OCALA: WATS: FAX: CreditApplicationsOCL@CheneyBrothers.com ONE CHENEY WAY PUNTA GORDA, FL PHONE: FAX: CreditApplicationsPUN@CheneyBrothers.com 3500 OLD BATTLEGROUND ROAD GREENSBORO, NC OFFICE FAX CreditApplicationsNC@CheneyBrothers.com (Revised 2018)

4 CHENEY BROTHERS, INC. FOOD DISTRIBUTORS Since SALES TAX CERTIFICATE AND/OR EXEMPTION AGREEMENT Customer Name: Customer Address: (Please Print Name) (Please Print Name) Account Number: Date: Customer acknowledges that it is obligated to pay all sales tax, discretionary surtax, and/or use tax that may be due and owing on goods and services it purchases from Cheney Bros. Inc. d/b/a Cheney Brothers, Inc. ( C-B-I ) and will indemnify and hold C-B-I harmless for any and all such taxes which C-B-I pays on Customer s behalf. Customer represents to C-B-I that Customer has obtained or is in the process of obtaining an Annual Resale Certificate for Sales Tax or Consumer s Certificate of Exemption to establish that it is not required to pay sales tax, discretionary surtax, and/or use tax on some or all of the goods and services it has contracted to or will contract to purchase from C-B-I. Based upon the forgoing representations, Customer requests that C-B-I process Customer s order(s) immediately and forbear from including the amount of tax that would be otherwise be due on goods and services for a period of thirty (30) days to provide Customer with sufficient time to provide C-B-I with a copy of an Annual Resale Certificate for Sales Tax or Consumer s Certificate of Exemption for the relevant year. If Customer fails to timely do so, Customer authorizes C-B-I to issue a revised or new invoice to Customer or otherwise charge Customer s account for the amount of taxes which C-B-I believes to be due. If Customer fails to pay said sum within ten (10) days of the date of the invoice, same shall constitute a default under Customer s credit application and/or invoice. Acknowledged and Agreed: Customer By: Its:

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6 Web-Fill 6-15 E-595E Streamlined Sales and Use Tax Agreement This is a multi-state form. Not all states allow all exemptions listed on this form. Purchasers are responsible for knowing if they qualify to claim exemption from tax in the state that would otherwise be due tax on this sale. The seller may be required to provide The purchaser will be held liable for any tax and interest, and possibly civil and criminal penalties imposed by the member state, if on a sale made at a location operated by the seller within the designated state if the state does not allow such an entity-based exemption Check if you are attaching the Multistate Supplemental form. If not, enter the two-letter postal abbreviation for the state under whose laws you are claiming exemption. Please print Name of purchaser. Business address City State Zip code Purchaser s tax ID number State of issue Country of issue If no tax ID number, FEIN Driver s license number/state issued ID number Foreign diplomat number enter one of the following: state of issue number 4 5 Name of seller from whom you are purchasing, leasing, or renting CHENEY BROS., INC. D/B/A CHENEY BROTHERS, INC. Seller s address City State Zip code 1 CHENEY WAY RIVIERA BEACH FL Type of business. Check the number that describes your business. 01 Accommodation and food services 02 Agricultural, forestry 03 Construction 04 Finance and insurance 05 Information, publishing, and communications 06 Manufacturing 07 Mining 08 Real estate 09 Rental and leasing 10 Retail trade Reason for exemption. A Federal government (department) B State or local government (name) C Tribal government (name) D Foreign diplomat # 11 Transportation and warehousing 12 Utilities 13 Wholesale trade 14 Business services 15 Professional services 16 Education and health-care services Government 19 Not a business 20 Other (explain) H Agricultural production # I Industrial production/manufacturing # J Direct pay permit # K Direct mail # L Other (explain) 6 G Resale # Sign here. Signature of authorized purchaser Print name here Title Date

7 Page 2 E-595E Web-Fill 6-15 Streamlined Sales and Use Tax Agreement Name of purchaser State Reason for exemption (if required) AR GA IA IN KS KY MI MN NC ND NE NJ NV OH OK RI SD TN* UT VT WA WI WV WY *SSUTA Direct Mail provisions are not in effect for Tennessee. 2

8 Page 3 E-595E Web-Fill 6-15 Streamlined Sales and Use Tax Agreement Use this form to claim exemption from sales tax on purchases of otherwise taxable items. The purchaser must claim exemption. Warning to purchaser: You are responsible for ensuring that you are eligible for the exemption you are claiming. You will be held liable for any tax and interest, and possibly penalties imposed by the member state to which the tax is due on your purchase, if the purchase is not legally exempt. 1. Some and, regularly, make exempt purchases from the same seller. If you do, check the box on the front of the Multistate Supplemental form on page 2. CAUTION: sellers and purchasers MUST BE AWARE that these additional non-member states may not have adopted relieve the seller from liability unless non-member states requirements have been met. If you are not attaching the Multistate Supplemental form, enter the two-letter postal abbreviation NC in the boxes provided if you are claiming an exemption from sales and use tax imposed by the State of North Carolina. If you are claiming an exemption from more than one member state, complete the of Exemption: Multistate Supplemental form. 2. Single single purchase. Include the invoice or purchase order number for the transaction. If continues in force so long as the purchaser is making recurring purchases (at least one purchase within a period of twelve consecutive months) or until otherwise cancelled by the purchaser. 3. Purchaser information: Complete the purchaser and seller information section, as requested. An use tax account ID number or North Carolina sales and use tax exemption number, as appropriate. If a transaction does not require the use of a registration or exemption number, enter the Federal Employer license number and the state from which it is issued. Foreign diplomats and consular personnel must enter Multistate Purchasers: The purchaser should enter its headquarters address as its business address. 4. Type of business: Check the number that best describes your business or organization. If none of the categories apply, check number 20 and provide a brief description. 5. Reason for exemption: Check the letter that applies to your business and enter the additional information requested for that exemption. If the member state that is due tax on your purchase does not require the additional information requested for the exemption reason code checked, enter NA for not applicable on the appropriate line. If an exemption that is not listed applies, check L Other and enter an explanation. The explanation for L Other must include a clear and concise explanation of the reason for the exemption claimed. 3

9 Page 4 E-595E Web-Fill 6-15 Streamlined Sales and Use Tax Agreement Multistate Purchasers: Attach the form and states in which the purchaser wishes to claim exemption from tax. CAUTION: The exemptions listed are general exemptions most commonly allowed by member states. However, each state s laws governing exemptions are different. Not all of the reasons listed may be valid exemptions in the state in which you are claiming exemption. In addition, each state has other exemptions that are not listed on this form. To determine what sales and use tax exemptions are allowed in a particular state refer to the state s web site or other information available relating to their exemptions. For see Section 52 of the Sales and Use Tax Technical Bulletins which can be found on the Department s website at or you may contact the Taxpayer Assistance and Collection Center at (toll free). Seller: You are required to maintain proper records of exempt transactions and provide those records to Member on the form are otherwise captured by the seller, the seller must maintain such data and make it available to Member states in the form in which it is maintained by the seller. You are relieved of the responsibility for collecting and remitting sales tax on the sale or sales for which the improperly claimed an exemption, provided all of the following conditions are met: 1. All and maintained; 2. The or as otherwise provided by Section 317 of the SSUTA; 3. If the purchaser is claiming an entity-based exemption (i.e., an exemption based on who the purchaser is), by the purchaser if the purchase was made at a sale location operated by the seller within that state; 4. You do not fraudulently fail to collect the tax due; or 5. You do not solicit customers to unlawfully claim an exemption. 4