All You Need, Mr. Mike's Market

Fleet Card Information

Corporate Application Information

Credit Limit Desired:
Year and State of Incorporation:
Corporate Name:
Type of Business:
Federal_ID:
Address:
City:
State:
Telephone:
No. of Employees in season:
Does Corporation own or rent these premises?

Other:

Type of Business:
Credit Limit Desired:
Own or Rent Premises:
Name(s):
d/b/a:
Business_Address:
City:
State:
Zip Code:
Social Security #:
Tax ID:
How many years in business:

Bank Accounts

Account #1
Name:
Account Number:
Type of Account:
Average Balance:
Account #2
Name:
Account Number:
Type of Account:
Average Balance:
Agent for Service:
Address:
City:
State:
Zip:

Credit References:

Please provide 4 credit references; at least 3 of which are local trade reference.
Reference #1:
Name:
Address:
Phone:
Average Balance Due:
Reference #2:
Name:
Address:
Phone:
Average Balance Due:
Reference #3:
Name:
Address:
Phone:
Average Balance Due:
Reference #4:
Name:
Address:
Phone:
Average Balance Due:
Name and Position or Office of Person Filling Out Application:

Corporate Officers and Titles:

President:
Name:
Address:
City:
State:
Zip
Home Phone:
Vice President:
Name:
Address:
City:
State:
Zip
Home Phone:
Treasurer:
Name:
Address:
City:
State:
Zip
Home Phone:

Credit Agreement:

For the purchasing of motor fuels, diesel fuels, lubricants and any other related mechandise, customer agrees to the following terms and conditions.

Customer understands that all bills must be paid within the period of time prominently displayed on each invoice and/or statement.

In the event of Customer's default in the payment of any statement when due, whether for products purchased or services rendered, or if P.O.C.I., who may thereupon take such action as it may deem advisable to enforce it's rights, all expenses therof including court costs and a reasonable attorney's fee to be borne by the Customer. A reasonable attorney's fee shall be thirty-three and one-third (33 1/3%) percent of the Customer's unpaid balance.

These terms and conditions shall be construed under and governed by the laws of Massachusetts or New Hampshire, Maine or applicable Federal Law or Regulations. If any provision of terms and conditions is in conflict with applicable law, that provision will be considered as amended or omitted so as to conform with the law, and the validity of the remaining terms and conditions shall not be affected.

The Customer authorizes P.O.C.I. in connection with the establishment and maintenance of the credit applied for, to investigate Customer's credit worthiness and capacity and to obtain credit information from third parties necessary for a determination therof. The Customer also authorizes P.O.C.I. to furnish information concerning Customer's account to consumer reporting agencies and others who may lawfully receive such information. The Customer certifies that the statements on this application form and on any additional page or pages accompanying this form are true and correct, and that no material information known to the Customer or specifically requested herein has been omitted. The Customer has read the above, has been given a copy of this Agreement and does hereby agree to abide by the terms and conditions as stated and those incorporated therein by reference should credit be extended to the Customer.

The Customer Agrees to the stated credit terms.

Customer's Signature/Date:

Personal Guaranty:

FOR VALUE RECEIVED, the undersigned (hereinafter "Guarantor") hereby guarantees payment of all obligations of the Customer (hereinafter "Debtor"), for services rendered and/or goods purchased, finance or other charges, collection costs, including without limitation attorney's fees, or otherwise, incurred as of the date of the application on the face herof or at any time subsequent hereto, to PETERBOROUGH OIL CO., INC (hereinafter "Creditor").

The obligation of Guarantor for the debts of the Debtor shall be primary along with the Debtor. Creditor shall be under no obligation to take measurers for enforcement or realization unpon any security or take any other action for the collection of any indebtedness due Creditor from Debtor prior to enforcing the obligations of Guarantor hereunder.

Guarantor hereby waives notice of the acceptance of this Guaranty and/or notice of any default in the payment of any indebtedness of Debtor to Creditor and of the incurring of any of the obligations aforesaid by Debtor, and of any other action which Creditor may take from time to time with respect to said indebtedness or any security thereof. Any waiver of any rights of Creditor against the Guarantor hereunder, in one or more instance, shall not constitute a waiver of any such rights of Creditor Subsequently.

This guaranty shall be binding upon the Guarantor, his heirs, executors, administrators, successors and assigns until the undersigned shall have given to Creditor notice in writing to make no further advances on the security of this Agreement; provided that such notice shall not lessen nor diminish in any way the liability of the undersigned for any indebtedness or liability incurred prior to receipt of such notice.

The Guarantor Agrees to the stated credit terms.

Guarantor Signature/Date:

Address:

Vehicles Requiring Card:

Please include vehicle number, if assigned, fuel type and tank/gallon maximum.
Vehicle #1:
Description:
Odometer:
Fuel Type:
Maximum Fill-up:
Vehicle #2:
Description:
Odometer:
Fuel Type:
Maximum Fill-up:
Vehicle #3:
Description:
Odometer:
Fuel Type:
Maximum Fill-up:
Vehicle #4:
Description:
Odometer:
Fuel Type:
Maximum Fill-up:
Vehicle #5:
Description:
Odometer:
Fuel Type:
Maximum Fill-up:
Vehicle #6:
Description:
Odometer:
Fuel Type:
Maximum Fill-up:
Vehicle #7:
Description:
Odometer:
Fuel Type:
Maximum Fill-up:
Vehicle #8:
Description:
Odometer:
Fuel Type:
Maximum Fill-up:
Vehicle #9:
Description:
Odometer:
Fuel Type:
Maximum Fill-up:
Vehicle #10:
Description:
Odometer:
Fuel Type:
Maximum Fill-up:
Please Enter All Authorized Drivers (Use a comma after each name):

Please Mail or Fax Printed Form to:

Attn: Jan Cochran
Peterborough Oil Co., Inc.
665 N. Main St.
P.O. Box 787
Leominster, MA 01453

Or Fax: (978) 537-4091