Credit Application

Business

Business Name

Address

City, State Zip

Phone

Fax

Federal Tax ID#

Trade Reference 1

Name

Address

City, State Zip

Phone

Fax

Trade Reference 2

Name

Address

City, State Zip

Phone

Fax

Bank Reference

Bank Name

Address

City, State Zip

Phone

Contact

Electronic Signature

Any misrepresentation in this application will be considered evidence of fraud, since this information is the basis for the extending of credit. As an inducement to grant credit, the undersigned warrants that the information submitted is true and correct. You are authorized to investigate the credit references and principals listed.

In consideration for the extension of credit, said business promises to pay for all purchases within the terms agreed as Net 30. In the event any third parties are employed to collect any outstanding monies owed by said business the undersigned agrees to pay reasonable collection costs, including attorney fees, whether or not litigation has commenced, and all costs of litigation incurred. The undersigned represents that he/she has the authority to execute this credit agreement on behalf of the business identified.

Name Of Business

Print Name

Title

Print Name

Title

Personal Guarantee

In consideration for Wheels America, Inc. extending credit to the business identified below for any materials and/or services after this date at the request of applicants or its agents, the undersigned individual hereby personally guarantees unconditionally and irrevocably the prompt payment of any sums now or hereafter owed to Wheels America Inc. by the business identified below whether said sums are due under open account, contract or otherwise.

It is understood and agreed that credit, if extended, is to be on a continuing basis and may exceed estimated maximum credit limit required as stated in the credit agreement between Wheel America, Inc. and shall not be obligated to notify the undersigned of the dates or amounts of any such credit and the undersigned waives demand, notice of default and any extension of time or any other forbearance which may be extended by Wheels America, Inc.

This guaranty shall continue in force until notice in writing, sent by registered or certified mail, return receipt requested is received by Wheels America Inc. Said notice shall specify the date on which this guaranty is to be terminated, said date not to be less than seven days after such notice is received. Such termination shall in no way release the undersigned as to any sum or debt incurred prior to such termination

Date

Name Of Person Guaranteeing Payment

Home address

City, State Zip

Home Phone #

Name of Business whose account is guaranteed

Terms And Conditions

I (the abovesigned) understand that by signing this credit application I am stating that I am a legal agent of the above mentioned applicant and that I have the authority to represent the applicant in this matter. Further, I hereby authorize Wheels America to contact the listed trade references and to inquire about the applicant's payment practices and other factors that may help Wheels America assess credit worthiness. I also authorize Wheels America to contact the banking references listed above and I authorize the bank to provide Wheels America with information regarding accounts and balances, lines of credit and other credit instruments. Further, I understand that I am authorizing Wheels America to access national, regional, or local database to obtain any information that may assist in assessing credit risk. Wheels America reserves the right to add interest to the outstanding balance monthly at the maximum rate of 1.5% should payment be delinquent beyond credit terms granted to the applicant, plus NSF or Stop Payment or Closed Account checks or revoked credit card payments will be charged $25 per occurrence.