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BUSINESS CONTACT INFORMATIONCompany Name:Bill-To Address:City: State: ZIP:Phone: Fax: Email:Type of Business: Sales Rep (if known):Type of Merchandise to be Purchased: q Agriculture q Propane* q Other:Principal Owner(s) or Chief Officer(s):Sole Proprietorship: Partnership: Corporation: State Incorporated: Other:BILLING INFORMATION:Preferred Delivery Method for Invoices and Monthly Statements (Required) q Email: q Fax:CREDIT REFERENCE INFORMATIONBank:Address:City: State: ZIP Code:Phone: Fax: Email:Bank Officer: Account #:BUSINESS/TRADE REFERENCES WHERE CREDIT IS EXTENDED-Please provide Fax numberCompany Name: Contact Name:Address:City: State: ZIP Code:Phone: Fax: Email:Company Name: Contact Name:Address:City: State: ZIP Code:Phone: Fax: Email:Company Name: Contact Name:Address:City: State: ZIP Code:Phone: Fax: Email:AGREEMENT989 W. Steeple Bay Parkway %u2022 Wichita, Kansas 67217 %u2022 Phone: 800-666-5764 %u2022 Fax: 800-685-9202 %u2022 Email: credit@fairbankequipment.comwww.fairbankequipment.comx xShip-To Address:City: State: ZIP:CREDIT APPLICATIONPlease provide Fax number or Email for all credit referencesTitle: Date: Title: Date: 1. We accept credit cards (VISA, MASTERCARD or AMERICAN EXPRESS including processing fee(s) where allowed by law), COD or Payment Terms based on approved credit. 2. Return Authorization # is required for all returns. Refused or returned merchandise are subject to a minimum 15% Re-Stocking Fee plus freight (some items are higher, and you will be notified if this is the case when return authorization is provided to you). 3. You agree that our liability is limited to the value of the product. 4. By submitting this application: a. You represent you are an authorized representative with authority to enter into this agreement. b. You authorize Fairbank Equipment, Inc. to make inquiries into you personally and into the banking and business/trade references that you have provided. c. You understand that the information given on this application will be held in strict confidence and used only for the purpose intended. d. You agree, if credit is extended, all decisions with respect to extension, continuation, and termination shall be at the sole discretion of Fairbank Equipment, Inc. 5. Wholesale Propane Parts & Equipment Purchase Agreement (for Propane customers) a. You certify that you are in one or more of the following propane related businesses: Propane Dealer, Propane Carburetion Installer, Propane Cylinder Filler, Heating Contractor, Certified Plumber, Hardware/Appliance Store, OEM/Manufacturer Utilizing Propane Components, Other (please explain)____________________________________________________________________________________________________________________ b. You understand that it is the policy of Fairbank Equipment, Inc., to sell propane parts & equipment only to companies that are qualified to install such products and that have liability insurance in the minimum amount of $300,000 per occurrence. c. You certify that you have a minimum of $300,000 in liability insurance and agree to provide proof of such insurance upon request. 6. ALL prices and terms are subject to change without prior notice. 7. YOU HEREBY CERTIFY THAT THESE STATEMENTS ARE CORRECT TO THE BEST OF YOUR KNOWLEDGE AND ARE MADE FOR THE PURPOSE OF OBTAINING FINANCING FROM FAIRBANK EQUIPMENT, INC. YOU AGREE TO PAY ALL COSTS INCLUDING ATTORNEY AND COLLECTION FEES SHOULD YOU FAIL TO PAY WITHIN THE APPROVED CREDIT TERMS. *See additional relevant agreement clauses for propane customers that you are acknowledging. 5222024