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 SIGN and FAX to Northwest Petroleum at (503) 655-5200

Business Name:   Phone:   

 Billing Address:    City:  

 State: Zip: Delivery Address:

 Doing Business as:   Sole Owner Partnership Corporation

  List Name(s) & Titles of Corporate Officer, Partners or Owner

       Name / Title

        Home Address

 Social Security#

 1.

 2.

 3.

 Business Information

 How long in business: How long at present address:

 Buying or Renting: Previous Fuel Provider:

 Federal ID#    PUC #

 Estimated Monthly Purchases:

 Trade References
       Name                                                         Address                           Zip            Phone       

1.

2.  

3.

 Bank References

 1..    

 2.   

 Contact Person at Bank:

 Type of Account Desired:   Cardlock (All taxes) Cardlock (fed taxes) Bulk Diesel                    

                                           On Road  Off Road

 NW Petroleum Office Use Only:
Date Opened:_____________  Acct#: ____________  Credit Limit:_____________

           Northwest Petroleum’s Terms & Conditions of Credit Sales   

 1. Our terms are net 30 days unless otherwise specified.

 2. Interest of 1 1/1% per month, which is an annual percentage rate of 18%, is charged on all
     past due balances.

 3. A fee of $20.00 will be charged for any and all returned checks. 

 4. The federal Equal Credit Opportunity Act prohibits creditors from discriminating against the
     applicants on the basis of race, color, religion, national origin, sex, marital status, age under
     the Consumer Credit Protection Act. 

 5. Northwest Petroleum  reserves the right to discontinue sales on credit at any time and for
     any lawful reason.     

 6. In the event of nonpayment of any invoice, applicant shall reimburse Northwest Petroleum
     for all costs and expenses reasonably incurred by Northwest Petroleum in connection with
     the default, including  without limitation, attorney fees.  Additionally, in the event a suit or
     action is filed with respect to any invoice or sale by Northwest Petroleum to applicant,
     Northwest Petroleum shall be reimbursed by applicant for all costs and expenses incurred
     in connection with the suit or action, including without limitation, reasonable attorney’s fees
     at arbitration, at trial and on appeal.       

 7. Applicant agrees that invoices and monthly statements are conclusive and accurate in all
     respects unless Applicant notifies Northwest Petroleum in writing within ten days of receipt
     of  the invoices or statement.   

 The undersigned applicant represents that all information on this application is true and correct
 and agrees to comply with all terms and conditions stated in the Terms and Conditions of Credit
 Sales. The applicant and the guarantor authorize Northwest Petroleum to obtain credit reports
 as to applicant, the owners of applicant and guarantor, and to otherwise verify financial
 information.   This application is to obtain commercial credit to be used for business purposes
 and not primarily  for personal, family or household purposes.   

 Print name: Signature:_______________________________

 Title: Date: