Business Credit Application

Company Legal Name*

Federal ID Number*

Incorporated*

Yes
No

Trade Name (If Different)

Billing Address*

Street Address Address Line 2 City State ZIP Code

Shipping Address

Street Address Address Line 2 City State ZIP Code

Owner's Name*

First Last

Social Security Number*

Owner's Phone Number*

Owner's Email*

Owner's Address*

Street Address Address Line 2 City State ZIP Code

Type of Business*

Monthly Credit Requested (Est.)*

Products (check all that apply)*

Auto Delivery Fuel
Will Call Fuel
Home Heating Oil
Agronomy
Grain
Feed
Propane
Store Purchases
Other

Year Established*

Accounts Payable Manager*

First Last

Present Location Since*

Accounts Payable Manager Phone Number*

Dun & Bradstreet Number

Trade Reference 1 Firm*

Trade Reference 1 Address*

Street Address Address Line 2 City State ZIP Code

Trade Reference 1 Phone Number*

Trade Reference 2 Firm*

Trade Reference 2 Address*

Street Address Address Line 2 City State ZIP Code

Trade Reference 2 Phone Number*

Trade Reference 3 Firm*

Trade Reference 3 Address*

Street Address Address Line 2 City State ZIP Code

Trade Reference 3 Phone Number*

Applicant Statement

I agree to pay the full purchase price for all goods, materials, equipment and/or services purchased from Centerra Co-op ("Centerra") within thirty (30) days of the billing date shown on each invoice or monthly account statement. If I do not make a full payment within thirty (30) days of the billing date on any invoice or monthly account statement, I agree that, in addition to any unpaid balance of principal, I will be subject to and hereby agree to pay a service charge of one and one-half percent (1.5 %) per month (annual percentage rate of 18 %), in addition to Centerra's attorney's fees incurred in collecting all delinquent account balances. I further agree to be bound by all of the terms and conditions set forth on both sides of any and all Centerra invoices or monthly account statements. My signature below indicates that I have read, understood, agree and covenant to be bound by the terms set forth in this Application and Centerra's invoices and account statements and that all information I have provided herein is true and accurate.

I hereby authorize the credit references named herein, in addition to any credit service companies or bureaus, to release any and all requested financial and credit information known to them to Centerra Co-op to be used for the purpose of evaluating this Application for Credit. I also represent that this account will be used primarily for business, commercial or agricultural use.

Bank Reference*

Officer Name*

First Last

Bank Address*

Street Address Address Line 2 City State ZIP Code

Bank Officer Phone Number*

Would you like a fuel card?*

Yes
No

Number of Cards*

Personal Guarantee

For value received, the undersigned, being an officer, shareholder, member or partner of the commercial applicant referenced above, does absolutely, irrevocably, unconditionally, and personally guarantee the prompt and punctual full payment, when due, by acceleration or otherwise, of each and every debt obligation now existing or hereafter incurred, created, or acquired of by said commercial applicant to Centerra Co-op, together with all finance charges, penalties, and other costs and expenses accruing thereon (including but not limited to Centerra Co-op's reasonable attorney fees).

Signature*

Guarantor Signature*

Business Credit Application

Applicant Statement

Personal Guarantee

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