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                                                                                Casey’s Distributing Credit Application 08-04-2017

CASEY’S CREDIT APPLICATION

SECTION ONE - ABOUT YOUR BUSINESS:

_____________________________________________                INDIVIDUAL ___  PARTNERSHIP ___        CORP ___

LEGAL FIRM NAME/DBA                                        

_____________________________________________                _____________________________________________

BILLING ADDRESS                                                ACCOUNT PAYABLE E-MAIL ADDRESS

_________________________        ____________        ______                _____________________________________________

CITY                                STATE                ZIP                WEBSITE ADDRESS

_____________________________________________                _____________________________________________

PHONE                                                                FAX

DATE STARTED _______________ ANNUAL SALES ____________OWN ___ RENT___ MO. PAYMENT $________

_________________________________________________________________________________________________

NAME OF: PRESIDENT(CEO):OWNER(SOLE PROPRIETOR); PARTNER                        

_________________________________________________________________________________________________

NAME OF OTHER: AUTHORIZED OFFICER(CFO) OWNER SPOUSE: PARTNER                

SECTION TWO - TRADE REFERENCES:

_________________________________________________________________________________________________

NAME                        ADDRESS                        ZIP                PHONE                FAX


_________________________________________________________________________________________________

NAME                        ADDRESS                        ZIP                PHONE                FAX

_________________________________________________________________________________________________

NAME                        ADDRESS                        ZIP                PHONE                FAX

SECTION THREE - BANK REFERENCES:

_________________________________________________________________________________________________

NAME OF BANK                                        BANK OFFICER        

_________________________________________________________________________________________________

ACCOUNT NO.                                                TYPE OF ACCOUNT                                


_________________________________________________________________________________________________

STREET ADDRESS                CITY                        STATE                        ZIP                PHONE                        

SECTION FOUR - PERSONAL GUARANTEE AGREEMENT:

THE UNDERSIGNED INDIVIDUAL, WHO IS EITHER A PRINCIPAL OF THE CREDIT APPLICANT OR A SOLE PROPRIETORSHIP OF THE CREDIT APPLICANT, RECOGNIZING THAT HIS OR HER INDIVIDUAL CREDIT HISTORY MAY BE A FACTOR IN THE EVALUATION OF THE CREDIT HISTORY OF THE APPLICANT, HEREBY CONSENTS TO  AND AUTHORIZES THE USE OF  A CONSUMER CREDIT REPORT ON THE UNDERSIGNED BY CASEY’S, FROM TIME TO TIME  AS MAY BE NEEDED, IN THE CREDIT EVALUATION PROCESS.

THE UNDERSIGNED HAS READ THIS CREDIT APPLICATION AND AGREES TO BE BOUND BY ITS STATEMENTS, TERMS, AND CONDITIONS STATED HEREIN.  THE UNDERSIGNED AGREES TO UPDATE THIS APPLICATION IF INFORMATION IS NO LONGER ACCURATE.

PERSONAL GUARANTEE MUST BE PROVIDED BY BOTH OWNER AND SPOUSE, IF SPOUSE IS DIRECTLY INVOLVED IN THE BUSINESS, AND SAID COMPANY IS LESS THAN (3) FULL YEARS IN BUSINESS.

I/WE REQUEST CASEYS DISTRIBUTING INC.(CASEYS), REFERRED HEREIN AS CREDITOR, TO GRANT CREDIT TO__________________________________________ REFERRED TO HEREIN AS THE DEBTOR, AND IN CONSIDERATION OF SUCH CREDIT, I AGREE WITH THE CREDITOR AS FOLLOWS:

  1. I/WE GUARANTEE UNCONDITIONALLY AND PROMISE TO PAY CREDITOR ALL DEBTOR’S INDEBTEDNESS TO CREDITOR, WITHOUT LIMITATION AS TO AMOUNT, UPON DEFAULT BY DEBTOR.
  2. THE INDEBTEDNESS SHALL INCLUDE ONLY THE INDEBTEDNESS INCURRED ON OR AFTER THE DATE OF THIS GUARANTEE.
  3. THIS IS A CONTINUING GUARANTEE AND UNTIL REVOKED SHALL COVER FUTURE INDEBTEDNESS ARISING UNDER SUCCESSIVE TRANSACTIONS THAT SHALL EITHER CONTINUE THE INDEBTEDNESS OR, FROM TIME TO TIME, RENEW IT AFTER IT HAS BEEN SATISFIED.
  4. THIS AGREEMENT SHALL INSURE TO THE BENEFIT OF CREDITOR, ITS SUCCESSORS AND ASSIGNS, AND SHALL BIND HEIRS, EXECUTORS, ADMINISTRATORS AND ASSIGNS.
  5. I AGREE TO PAY MY CREDITOR REASONABLE ATTORNEY FEES, ALL COSTS, AND OTHER EXPENSES INCURRED BY IT IN COLLECTING ANY INDEBTEDNESS OF DEBTOR HEREBY GUARANTEED OR IN ENFORCING THIS GUARANTEE AGAINST ME/US.
  6. THIS CONTINUING GUARANTEE SHALL REMAIN IN FULL FORCE UNTIL AND UNLESS I/WE DELIVER TO CREDITOR, BY CERTIFIED MAIL, RETURN RECEIPT REQUESTED, WRITTEN NOTICE REVOKING THIS GUARANTEE.  SUCH REVOCATION SHALL NOT AFFECT ANY OF MY/OUR OBLIGATIONS WITH RESPECT TO SUCH INDEBTEDNESS INCURRED PRIOR TO REVOCATION.
  7. THIS LIABILITY OF THE UNDERSIGNED SHALL NOT BE IMPAIRED, ALTERED OR OTHERWISE AFFECTED BY ANY RENEWAL, MODIFICATION, COMPROMISE OR DISCHARGE OF THE INDEBTEDNESS OR ANY PART THEREOF.
  8. CREDITOR MAY CEASE FURTHER SALES AND DELIVERIES AT ANY TIME, BUT AGREE THAT IT WILL, UPON WRITTEN REQUEST, FURNISH TO THE UNDERSIGNED A COMPLETE STATEMENT OF THE AMOUNT OF THE INDEBTEDNESS COVERED BY THIS GUARANTEE AND THEN UNPAID.
  9. THIS APPLICANT AND THE UNDERSIGNED HAVE GIVEN THE ABOVE INFORMATION TO INDUCE YOU TO FURNISH MATERIALS AND/OR SERVICES ON CREDIT AND REPRESENTS THAT SAID INFORMATION IS ACCURATE AND COMPLETE.

By signing, Member agrees to CASEY’S DISTRIBUTING, INC. MEMBERSHIP TERMS AND CONDITIONS. For the most current Terms and Conditions, please visit http://www.caseys-distributing.biz/terms.html 

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SIGNED                PRINT NAME                        SOCIAL SECURITY NO.                DATE

_________________________________________________________________________________________________

RESIDENCE ADDRESS                CITY                        STATE                ZIP                PHONE        

_________________________________________________________________________________________________

SIGNED                PRINT NAME                        SOCIAL SECURITY NO.                DATE

_________________________________________________________________________________________________

RESIDENCE ADDRESS                CITY                        STATE                ZIP                PHONE

INCLUDE A CURRENT FINANCIAL STATEMENT OR LAST FEDERAL FILING FORM ON GUARANTOR(S).

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