Consumer Account Application

Before anyone is allowed to charge, they must complete a credit application and meet our credit policy requirements. We will pull the applicants/business guarantors credit report to determine credit eligibility. Patron/Dividend only accounts are not charge accounts. Open account patrons will be billed monthly and statements will be mailed as soon as administratively feasible following the close of the month. All open accounts will be due and payable, in full, on the last business day of the month following the month of purchase. If payment is not received by the statement due date, the account will be put on COD. Credit on all products and services will be discontinued immediately. Open accounts that are continuously delinquent and past due 90 days will be put on a cash basis indefinitely!! The company will not be held responsible for regular scheduled deliveries (keep full) if the patron's account is past due. All past due accounts must be paid before the next delivery will be made. Minimum deliveries for bulk LP are 250 gallons. For gas and fuel it's 200 gallons. There will be an additional fee if the minimum is not met. Cash customers must pay for deliveries in full before the delivery is made. Fuel assistance cash customers must have their percentage paid in full before delivery will be made. A finance charge of 1.5% per month, or an annual percentage rate of 18% will be charged on any amount over 30 days old. Management will determine the dollar amount of credit given to any individual or company. Management reserves the right to refuse or limit credit privileges to anyone, at any time, based on ability to pay, financial condition & previous experience, as we see fit. Suppliers' liens will be filed on accounts over 90 days or as needed. (to be determined by credit manager)

Enerbase makes every reasonable effort to obtain information you require on your tickets, (bulk deliveries) including signatures, PO numbers, etc. However, it is the primary responsibility of the business seeking credit to insist that their employees provide all information at the time of the sale.

DEAR PATRON: To comply with federal laws in reporting 1099 patronage dividends, we must also report the social security number or federal identification number of all patrons receiving dividends. If this is not reported, the internal revenue service will now assess your cooperative a $50 penalty for each patron not having a social security number or a federal identification number. To comply with federal law and to avoid a $50 penalty, we need the following information on file.

I hereby consent to include in my gross income, as now or hereafter provided in the federal income tax laws, the stated dollar amount of each written notice of allocation which I receive from Enerbase with respect to my patronage occurring during the current and all subsequent taxable years of this cooperative. This individual consent shall be revocable by me at any time if in writing.

Under the penalties of perjury, I certify that the information provided on this form is true, correct, and complete.

Thank you very much for your application. To better serve you please indicate how you are planning to use your new Enerbase charge account:

Remember you will not be able to charge at the C-Stores without an Enerbase Card

1. The Enerbase card is NOT a credit card. The statement balance is due by the last business day of the month billed. Finance charges will be incurred for all amounts past due.
2. We CANNOT restrict your charge cards. You must speak with your family about what they are allowed to charge.
3. We WILL NOT give receipt copies. It is the responsibility of the person making the purchase to keep track of the receipt if it is needed.
4. If a purchase is PAID AT THE PUMP the receipt will print at the pump. If the pump is out of paper the purchaser can obtain a copy from inside. We cannot provide a receipt later because the purchaser did not come in to sign a receipt.
5. The cards are numbered. Make sure to keep track of who has which card number in case one card needs to be cancelled.
6. If a card is LOST OR STOLEN you are responsible for all charges until we are made aware. We will need to know the number of the card to shut it down so please make sure all cards are accounted for.
7. If you do not receive a statement please contact the office if charges were made. We do not know if your mail was not properly delivered.