Business Name     Business Phone

 Street Address         Fax

 City   State   Zip   Mobile Phone

 Sole Proprietor   Partnership Corporation     Email

 Type of Business    Fed ID#

 Year Established   State Tax Exempt? No  Yes   State Tax#

 At Present Location Since Length of time owners have operated business

 LIST ALL OWNERS, PARTNERS, and/or OFFICERS

 Name   Title   Phone

 Name   Title   Phone

 Name   Title   Phone

 BANK REFERENCE

 Name of Bank Address City ST Zip:

 Account# Phone Contact

 TRADE REFERENCES

 Company Name Phone Fax#

 Address City   ST  ZIP

 Company Name Phone Fax#

 Address City ST  ZIP

 Company Name Phone Fax#

 Address City  ST  ZIP

PERSONAL GUARANTEE: I, the undersigned, have read and executed the guaranty on the reverse side of this form. I understand that my execution of the guaranty is a condition to the extension of credit pursuant to this application. I also understand that in the event that credit is granted by virtue of this application I am agreeing, by terms of the guaranty, to be personally responsible for any outstanding balance and interest thereon should payments not be made on this account per terms of saleI authorize the access of consumer credit reporting entities files as they pertain to my personal credit history.

 PERSONALLY GUARANTEED BY DATE SS#

Kath is advising you that if at any time you use the services of a Third-Party Payor you will be ultimately responsible for payment of all fuel and other products Kath delivers to you. Your payment to any Third-Party Payor will not relieve you of your obligation to pay Kath in the event the Third-Party Payor fails to forward your payment to Kath.

I HAVE READ AND AGREE TO THE TERMS AND CONDITIONS OF SALE ON THE REVERSE. I AUTHORIZE THE RELEASE OF CREDIT AND FINANCIAL INFORMATION TO KATH FUEL OIL SERVICE BY ALL BANK AND TRADE REFERENCES LISTED ON THIS APPLICATION.

 FOR SIGNED BY TITLE DATE