ADDENDUM TO THE FUEL CARD SERVICES AGREEMENT BETWEEN WEX BANK AND THE STATE OF WASHINGTON (the “STATE”)Card Services Agreement • February 18th, 2021
Contract Type FiledFebruary 18th, 2021CREDIT INFORMATION Purchasing Entity has requested a credit account pursuant to the Amended and Restated Cooperative Purchasing Master Agreement No. 00819 (“Agreement”) entered into between WEX Bank (“WEX”) and the State of W ashington, Department of Enterprise Services (the “State”) and thereby creating the program (“Program”) by which to enroll participants (“Purchasing Entity”). By enrolling in this Program, the Purchasing Entity named below agrees that in the event their account is not paid as agreed, WEX may report the undersigned’sliability for and the status of the account to credit bureaus and others who may lawfully receive such information. Purchasing Entity Name Phone # Fax# Physical Address (Do not include PO Box) Mailing Address (if different from physical address) MCUA Member ID Number Purchasing Entity’s Taxpayer ID # (TIN, FEIN or SSN) In Business Since (yyyy) Year of Incorporation (yyyy) Number of Vehicles Avg Monthly Fuel Expenditures Avg Monthly Service Expenditures