Application for Credit for My Business Section A - Business Information Business Type Corporation Partnership Proprietorship (supply SSN) Other Street Address Mailing Address (if different from street address) Delivery Address (if different from street address) Phone Number(s) How did you hear about us? Advertisement Newspaper Television Commercial Referral Other (fill in below) Section B - Bank References Bank Type Checking Loan Savings Section C - Credit References Reference 1 Reference 2 Current or Previous Supplier Section D - Petroleum Product Information Payment Terms Unless otherwise noted in this form, the following payment terms apply: Commercial - Payment is due within thirty (30) days from the date of delivery. A finance charge on amounts past due after thirty (30) days will be added at the rate of 1.5% per month (APR 18%) or $1.00, whichever is greater, on the unpaid balance. Transport - Payment is due in full withing 10 days, or other pre-arranged terms, from the date of delivery. A finance charge on amounts past due will be added at the rate of 1.5% per month (APR 18%) or $1.00, whichever is greater. Authorization Agreement for Preauthorized (EFT) Payments if applicable I (we) authorize Davenport Energy, hereinafter called Company, to initiate debit entries to my (our) checking account indicated below and the bank named below, hereinafter called Depository, to debit the same to such account. This authority is to remain in full force and effect until the Company and Depository has received written notification from me of its termination in such time and in such manner as to afford Company and Depository a reasonable opportunity to work. The undersigned hereby submits this application for the purpose of applying for a credit account with Davenport Energy, affirms that the information provided herein is true and accurate and acknowledges and accepts the provisions noted above, and further gives Davenport Energy permission to obtain a credit history now, and again in the future, if conditions warrant, using the applicants Social Security Number. Upon approval of credit, the undersigned agrees to pay promptly and within thirty (30) days (or as otherwise notified in this agreement) from the date of delivery or services rendered. If payment is not received within thirty (30) days, or as otherwise noted in this agreement, Davenport Energy may, at its option and without notice, not make a delivery, or terminate service, and remove company-owned property and gas from the delivery address. The undersigned agrees to pay any and all collection and/or attorney's fees and all legal costs incurred or obligated by Davenport Energy in enforcement and/or collection of this agreement. The undersigned understand that a late payment charge in the amount of 1.5% per month (APR 18%) or $1.00, whichever is greater, will be added, if payment is not received within thirty (30) days, or as otherwise noted in this agreement, and shall continue each 30 days thereafter, until the past due balance is paid in full. Davenport Energy will charge the maximum allowable fee for any check returned for insufficient funds. Further, the undersigned agrees to pay this account and personally guarantees and stands for the credit and all lawful charges of the above named applicant made to Davenport Energy. Signature I have read and agree to the terms listed above and the Davenport Terms and Conditions. I understand and agree that this application is being submitted electronically via the Davenport website at www.davenportenergy.com and that my typed name below shall constitute my signature on this application. My signature indicates that I agree to the Account Terms and Conditions as displayed online and recorded in this document. I understand that I will automatically receive a copy of this electronic application via email upon submission. Electronic signature Submitting this form Type the characters shown in the box provided and click submit.