Common use of PLEASE ANSWER ALL QUESTIONS Clause in Contracts

PLEASE ANSWER ALL QUESTIONS. (If more space is needed, a continuation sheet may be attached.) How were you referred to P-Fleet? ☐ Another Customer ☐ Driver ☐ P-Fleet Rep ☐ Mailer ☐ Google ☐ Yahoo ☐ Other (specify): COMPANY INFORMATION Company Name ☐ LLC ☐ Incorporated ☐ Partnership ☐ Proprietorship State DBA Federal ID # D&B # Industry Physical Address City State Zip Mailing Address City State Zip Years in Business If less than 1 year, previous business name and address: Primary Contact Phone Fax E-Mail Payables Contact Phone Fax E-Mail Has your company ever filed Bankruptcy? ☐ Yes ☐ No If yes, what chapter? Date of Filing BANK INFORMATION Bank Acct # City State Phone Contact Bank Acct # City State Phone Contact BUSINESS CREDIT REFERENCES Fuel Supplier Monthly Gallons City State Phone Fax Vendor City State Phone Fax Vendor City State Phone Fax Does your company own Real Property? ☐ Yes ☐ No If yes, address: OFFICERS OF COMPANY Name Title SS # Home Address City State Zip ☐ Own ☐ Rent Name Title SS # Home Address City State Zip ☐ Own ☐ Rent CONVENIENT PAY ENROLLMENT AND AUTHORIZATION AGREEMENT P-Fleet is hereby authorized to pay and charge Customer’s account electronically for properly supported charges due and owing P-Fleet only. This authorization will remain in effect until revoked by Customer in writing, and until such notice is actually received, Financial Institution will be fully protected in honoring any such electronic transfer. This Agreement allows P-Fleet to charge debits to Customer’s account at frequent intervals for varying amounts. It is acknowledged and accepted that the debits owed to P-Fleet will typically be paid on the due date or next business day. P-Fleet will notify Customer by fax of any and all impending debits. THERE WILL BE A $50 CHARGE BY P-Fleet FOR ANY ELECTRONIC TRANSFER RETURNED UNPAID. In the event a debit is shown to be made erroneously, P-Fleet agrees to correct such error immediately. Financial Institution Name Branch Phone Bank Routing # Checking Acct # Signature X Print Name Title Date TERMS AND CONDITIONS The Customer fully understands and agrees to comply with the following terms and conditions of this Agreement.

PLEASE ANSWER ALL QUESTIONS. (If more space is needed, a continuation sheet may be attached.) How were you referred to P-Fleet? ☐ Another Customer ☐ Driver ☐ P-Fleet Rep ☐ Mailer ☐ Google ☐ Yahoo ☐ Other (specify): COMPANY INFORMATION Company Name ☐ LLC ☐ Incorporated ☐ Partnership ☐ Proprietorship State DBA Federal ID # D&B # Industry Physical Address City State Zip Mailing Address City State Zip Years in Business If less than 1 year, previous business name and address: Primary Contact Phone Fax E-Mail Payables Contact Phone Fax E-Mail Has your company ever filed Bankruptcy? ☐ Yes ☐ No If yes, what chapter? Date of Filing BANK INFORMATION Bank Acct # City State Phone Contact Bank Acct # City State Phone Contact BUSINESS CREDIT REFERENCES Fuel Supplier Monthly Gallons City State Phone Fax Vendor City State Phone Fax Vendor City State Phone Fax Does your company own Real Property? ☐ Yes ☐ No If yes, address: OFFICERS OF COMPANY Name Title SS # Home Address City State Zip ☐ Own ☐ Rent Name Title SS # Home Address City State Zip ☐ Own ☐ Rent CONVENIENT PAY ENROLLMENT AND AUTHORIZATION AGREEMENT P-Fleet is hereby authorized to pay and charge Customer’s account electronically for properly supported charges due and owing P-Fleet only. This authorization will remain in effect until revoked by Customer Xxxxxxxx in writing, and until such notice is actually received, Financial Institution will be fully protected in honoring any such electronic transfer. This Agreement allows P-Fleet to charge debits to Customer’s account at frequent intervals for varying amounts. It is acknowledged and accepted that the debits owed to P-Fleet will typically be paid on the due date or next business day. P-Fleet will notify Customer by fax of any and all impending debits. THERE WILL BE A $50 CHARGE BY P-Fleet FOR ANY ELECTRONIC TRANSFER RETURNED UNPAID. In the event a debit is shown to be made erroneously, P-Fleet agrees to correct such error immediately. Financial Institution Name Branch Phone Bank Routing # Checking Acct # Signature X Print Name Title Date TERMS AND CONDITIONS The Customer fully understands and agrees to comply with the following terms and conditions of this Agreement.

PLEASE ANSWER ALL QUESTIONS. (If more space is needed, a continuation sheet may be attached.) How were you referred to P-Fleet? ☐ Another Customer Contracting Company ☐ Driver ☐ P-Fleet Rep ☐ Mailer ☐ Google ☐ Yahoo ☐ Other (specify): COMPANY INFORMATION Company Name ☐ LLC ☐ Incorporated ☐ Partnership ☐ Proprietorship State DBA Federal ID # D&B # Industry Physical First Name Last Name Title Address City State Zip Mailing Address Home Phone Cell Phone Email SS # Fed Tax ID # Contractor ID # Which company are you contracted with? When did your contract start? (Month/Day/Year) Which other companies do you run for? Manager Name/Profit Center City State Zip Years in Business If less than 1 year, previous business name and address: Primary Contact Phone Fax E-Mail Payables Contact Do you own or lease your truck(s)? ☐ Own ☐ Lease Leasing Company Phone Fax E-Mail Has Does your contracting company ever filed Bankruptcyoffer insurance? ☐ Yes ☐ No If yes, what chapter? Date of Filing BANK INFORMATION Bank Acct # Insurance Company Phone WORK HISTORY Previous Company City State Phone Contact Bank Acct # Previous Company City State Phone Contact BUSINESS CREDIT REFERENCES Fuel Supplier Monthly Gallons City State Phone Fax Vendor City State Phone Fax Vendor City State Phone Fax Does DRIVERS AND VEHICLES To order your company own Real Property? card(s), please list driver(s), including you, and select a shipping option: ☐ Yes Standard (free) ☐ No If yes, address: OFFICERS OF COMPANY Next Day (fee varies by location and is applied to your invoice) Driver Name Title SS Vehicle # Home Address City State Zip ☐ Own ☐ Rent Vehicle Description Driver Name Title SS Vehicle # Home Address City State Zip ☐ Own ☐ Rent CONVENIENT PAY ENROLLMENT Vehicle Description Driver Name Vehicle # Vehicle Description Driver Name Vehicle # Vehicle Description Driver Name Vehicle # Vehicle Description PERSONAL GUARANTEE AND AUTHORIZATION AGREEMENT TERMS AND CONDITIONS Signature States Signateur (“Guarantor”) Personally Guarantees (“Guarantee”) debts for the above Applicant. Permission is herewith granted to obtain credit information from all listed references including my bank. By signing this Agreement and using services of P-Fleet is hereby Fleet, I certify that I am authorized to pay make this request on behalf of this company, and charge Customer’s account electronically for properly supported charges it is agreed that all purchases will be paid in accordance with the terms and conditions. Terms and Conditions of Sale are set forth on the reverse side or following page(s). The undersigned hereby executes this Agreement on behalf of the Customer as an authorized representative of the Customer and individually as the Guarantor of the Customer and hereby assumes personal and individual responsibility and liability for, and guarantee payment of, all amounts due and owing P-Fleet only. This authorization will remain in effect until revoked by Customer in writing, and until such notice is actually received, Financial Institution will be fully protected in honoring any such electronic transfer. This Agreement allows P-Fleet to charge debits to Customer’s account at frequent intervals for varying amounts. It is acknowledged and accepted that the debits owed payable to P-Fleet will typically be paid on at any time by the due date or next business dayCustomer. P-Fleet will notify Customer by fax I hereby consent to and authorize the use of any my consumer credit report in the credit evaluation process. By signing this Agreement, Applicant acknowledges and all impending debits. THERE WILL BE A $50 CHARGE BY P-Fleet FOR ANY ELECTRONIC TRANSFER RETURNED UNPAID. In the event a debit is shown to be made erroneously, P-Fleet agrees to without exception all terms, conditions, authorizations and disclosures provided with this Agreement including the attached Terms and Conditions of Sale and affirms that all information provided is true and correct such error immediatelyto the best of his/her knowledge. Financial Institution Name Branch Phone Bank Routing # Checking Acct # Signature X Print Name Title Date PLEASE RETURN THIS FORM TO P-FLEET FAX: 0-000-000-0000 │ EMAIL: XXXXX@XXXXXX.XXX │ OR MAIL TO: 0000 XXXXXXXXX XXXXX, XXXXX 000, XXX XXXXX, XX 00000 TERMS AND CONDITIONS The Customer fully understands and agrees to comply with the following terms and conditions of this Agreement.