BEND: 913 N.E 1st / PO Box 7437 Bend, OR (541) fax: (541)

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1 MORO: st / PO Box 344 Moro, OR BEND: 913 N.E 1st / PO Box 7437 Bend, OR (541) fax: (541) Thank you for your interest, we look forward to doing business with you! In an effort to process your account, and get fuel cards out to you as quickly as possible, we ask that you take the time to ensure that the necessary documents have been filled out in their entirety. Please return the following completed documents: Credit Application Cardlock Certification Fire Safety Training Certificate Card Order Form Completed packets can be faxed to ; ed to credit@mcpcoop.com; Mailed to PO Box 344, Moro, OR or delivered to either our Bend or Moro offices in person. Completed applications will be processed immediately and upon approval cards will be mailed, unless otherwise indicated. Please note that cards are NOT mailed with the PIN s. If receiving cards via mail, please call for PIN s once the cards have been received. If you have any questions, please feel free to contact us at (541) or (877) With Supervised Fuels and MCP you will be getting 24/7 access to fuel Little or no waiting in line at the pump Access to multiple commercial fueling networks Card controls on products, gallons and more Suspect usage monitoring Online account access Competitive pricing And much, much more!

2 APPLICATION FOR CREDIT Please check all that apply Requesting credit for: Credit Limit Requested: $ Grain *Cardlock Fuel Bulk Delivery / Lube Other: Farm Store Seed Tanker Delivery Home Heating Oil PLEASE COMPLETE THE APPLICABLE SECTION (EITHER BUSINESS OR PERSONAL) AND CREDIT REFERENCES BUSINESSES: (Please print, complete all pages of form) Company Name: Federal EIN# (not SSN): Street Address: City: State: Zip: Mailing Address: City: State: Zip: Phone #: Fax #: Cell #: A/P Contact & Principal Owners or Officers: All info is required to open an account. Last Name: Full First: Full Middle: SSN: Date of Birth: Home Phone: Last Name: Full First: Full Middle: SSN: Date of Birth: Home Phone: PERSONAL: (Please print, complete all spaces below) Last Name: Full First: Full Middle: Street Address: City: State: Zip: Mailing Address: City: State: Zip: Phone #: Fax #: Cell #: SSN: Date of Birth: Employer s Name: Phone: Spouse s Full Name (if joint account): SSN: DOB: Spouse s Employer Name: Phone: CREDIT REFERENCES: (Use established credit only, not personal references. Please use local business credit if possible.) Business Name: Phone: Acct #: Business Name: Phone: Acct #: Business Name: Phone: Acct #:

3 CUSTOMER AGREEMENT In submitting the application I authorize Mid Columbia Producers, Inc. ( MCP ) and/or Bend Oil Company ( BOC ) to investigate my credit record and if an account is established, furnish information concerning my credit file to consumer reporting agencies and other proper recipients. MCP and/or BOC reserves the right to deny credit for the following reasons; bankruptcy, past or present liens, suits or judgment, accounts listed for collection (paid or unpaid), two or more slow accounts, or a rating of nine, indicating repossession or a write off. Other factors may include a record of slow payment with other suppliers/vendors, prior negative credit experience with Mid Columbia Producers, Inc. or Bend Oil Company or insufficient credit information on which to make a judgment. I agree to pay the full balance of this account by the 25th of each month (unless terms are prearranged). MCP and/or BOC reserves the right to discontinue credit privileges, and/or fuel access card use, to any past due account without prior notice. If fuel cards are granted, Customer acknowledges receipt of fuel access cards and responsibility for the use of the cards for fuel charges including any fraudulent activity. If this account is placed in the hands of an attorney for collection or turned over to any agency for collection, the undersigned agrees to pay reasonable attorney s fees even if no suit or action is filed thereon. If a suit or action is filed, the amount of attorney s fees shall be fixed by the Court, or Courts in which the suit or actions, including any appeal therein is tried, and decided. Should my account or any part thereof, be placed with a collection agency for recovery, I understand and agree that the amount owed will be increased by a factor of 66.7% to cover collections costs. In the event security is granted for any transaction, Seller may exercise all the rights granted to secured party under the security transaction provision of the Uniform Commercial Code. I authorize the Seller to apply any payment to my account in the following order: (1) Finance Charges, (2) The purchases in date order, starting with the oldest purchases. Finance charges accrue at 1.5% per month. This application for credit has been made in Sherman County, Oregon and as part of the consideration for granting credit the applicant consents to jurisdiction of courts located in Sherman County, Oregon, for collection of accounts arising subsequent to this credit application. I/We agree to allow our unpaid account balance to be deducted from any cash disbursements due to us from MCP. Such disbursements may be for but not limited to: contract services performed, cash patronage payments, capital reserve redemption payments, grain sales payments, etc. I, if an employee of MCP, agree to allow MCP to deduct from my wages any amounts owed for goods or services purchased or for money borrowed or advanced from MCP or my MCP employee pension plan. Accepted and agreed to by: (printed name) Signature: State & Driver s License: Date: Accepted and agreed to by: (printed name) Signature: State & Driver s License: Date:

4 GUARANTOR AGREEMENT This section applies to all business applications and must be signed, in addition to the above Customer Agreement, by the Corporate Officers. I/We, the undersigned ( Guarantor ) hereby personally, unconditionally and irrevocably guarantees the payment of the obligations of the corporation, limited partnership, limited liability company, limited liability partnership, business entity or other person ( Customer ) of each and every obligation of this Customer Agreement. This Guarantee shall be continuing and shall terminate only upon the satisfaction of each and every one of the obligations under this Customer Agreement. Guarantor agrees that Mid Columbia Producers, Inc. ( MCP ) and/or Bend Oil Company ( BOC ) may from time to time extend the time for performance or otherwise modify, alter, or change the Customer Agreement and any or all provisions thereof, may extend the time for payment of all sums hereby guaranteed, and may receive and accept notes, checks, and other instruments for payment of money made by Customer and extensions or renewals thereof, without in any way releasing or discharging Guarantor from Guarantor s obligations hereunder. MCP and/or BOC may enforce this guarantee without first exhausting remedies against Customer nor has MCP and/or BOC any obligation to marshal funds or assets of Customer. This guarantee shall not be released, extinguished, modified, or in any way affected by failure on the part of MCP and/or BOC or assigns to enforce all rights or remedies available to it under the Customer Agreement. In the event suit or action is brought by any party under this Guarantee to enforce any of it s terms, it is agreed that the prevailing party shall be entitled to a reasonable attorney fee to be paid by losing party and be fixed by the trial and appellate courts. Print Full Name: Social Security #: Home Address: Signature: Date: DL#: Print Full Name: Social Security #: Home Address: Signature: Date: DL#: NAME OF MEMBER ASSOCIATION Return completed application to one of the following locations: Moro Office In Person: 2003 First St Mail: PO Box 344 Moro, OR Bend Office In Person: 913 NE 1st St Mail: PO Box 7437 Bend, OR Fax: (541) credit@mcpcoop.com Phone:

5 Bank Verification APPLICANT: Fill in the top portion only, including signature and date. We will send this form to your bank. To: Bank Address City, State, Zip Savings Account Number Phone Fax Name of Depositor Checking Account Number To the above named bank: I hereby request and authorize you to disclose the information requested below. Please accept this form regardless of the mode of receipt. Date: Depositor/Applicant: Signature: FOR BANK USE ONLY: We would appreciate you furnishing the information indicated below, in connection with our consideration of credit for the above applicant. Checking Account: Date Opened: Ave. Balance: Savings Account: Date Opened: Ave. Balance: Loan(s) outstanding: Date Incurred: Payment Current?: Original Amount: Current Balance Due: Any NSF checks in the last 12 months? No Yes Please comment on any information that may assist us in our decision: It is important to us, and your depositor, to have this information as soon as possible. Thank you for your courtesy and assistance. Please fax completed form to (541) or to credit@mcpcoop.com

6 MORO: st / PO Box 344 Moro, OR BEND: 913 N.E 1st / PO Box 7437 Bend, OR (541) fax: (541) CARDLOCK CERTIFICATION CFN and/or Pacific Pride Cards ONLY: ACCOUNT NAME: ACCOUNT #: I hereby certify that the above person or entity meets the following criteria: (Read carefully and check one) 1. Purchasing Diesel only. 2. A business, non-profit organization, charitable organization or governmental agency which was using a cardlock system continuously since 6/30/91. (Must supply documentation dated prior to 6/30/91). 3. A business, non-profit organization, charitable organization or governmental agency which became a card lock user after 6/30/91 AND agree to purchase 900 gallons or more of fuel (gasoline and diesel combined Class 1 Flammable liquid) from any source during each 12 month period AND agree to supply proof of gallon use upon request of Mid Columbia Producers, Supervised Fuels or the State Fire Marshal. 4. A Farmer or other entity for which the fuel purchased through the cardlock system qualifies as a deductible farm expense for Federal Income Tax purposes. (Mus supply a current Schedule F, see below). 5. A governmental agency providing Fire, Ambulance or Police services. I further agree to dispense Class 1 flammable liquids into container or the tank of a motor vehicle that is owned or used solely by the business identified above. I also agree that no personal use is allowed at any time and I understand that I am subject to a citation by the State Fire Marshal for violating this agreement. * * * * I have included one of the following (unless diesel only box is marked above)* * * * ***SSN # does NOT apply here, must provide one of the items listed Federal FEIN #* below as proof of business if you do not have a valid FEIN. *** Copy of current Contractors License Copy of P.U.C. permit Copy of Income Tax Sched C Profit & Loss from a Business (***ENTIRE FRONT PAGE***) Copy of Income Tax Sched F Profit & Loss from Farming (**Gasoline, Fuel & Oil line MUST have a number on it**) Moro / Wasco Conditional Use Site Cards ONLY: Moro Only Wasco Only both Moro & Wasco (select one) In order to comply with Oregon Revised Statutes, ORS to and Oregon Administrative Rules OAR to , all Oregon Conditional Use Cardlock/Keylock customers must meet and agree to the criteria listed below. Read each portion of this agreement carefully before signing. 1. This agreement is for access to Class 1 flammable liquids at the Conditional Use facility located in Moro, OR or Wasco, OR. Cards provide access to the dispensing equipment at one of these facilities ONLY. Each facility will be issued a card for sole use at that facility. 2. I agree to dispense Class 1 flammable liquids only into the tank of motor vehicles or containers that are OWNED or USED by the person specified above. 3. I certify each person allowed to dispense Class 1 flammable liquids from my account has received fire safety training as required by the State Fire Marshal before dispensing any gasoline. Under ORS , falsely certifying you are qualified as a non-retail fuel customer or the above information is true and correct, when it is not, can lead to criminal prosecution. ALL CARDS (CFN, Pacific Pride, Moro, Wasco): By signing this agreement, I certify that all information provided and agreed to is true and correct. I also certify that I have satisfied the safety training requirements in compliance with the rules of the State Fire Marshal. Signature Date Drivers Lic # SSN Birth Date Do you have vehicles with PUC plates? If so, in order to purchase Oregon State Tax exempt diesel, you must provide a copy of your PUC permit and a tax exemption certificate (Ask us for this form).

7 FIRE SAFETY TRAINING PLEASE READ CAREFULLY The following are guidelines you MUST follow when using a cardlock facility. NO SMOKING Smoking is not permitted. Doing so could result in a serious fire and/or injury. FIRE EXTINGUISHER LOCATION & USE Location and instructions for use must be conspicuously posted. TO USE: 1. Hold the extinguisher upright, pull ring pin. 2. Stand back 8 feet from the fire. 3. Aim at base of fire and squeeze lever. 4. Sweep side to side. IDENTIFY EMERGENCY EQUIPMENT Emergency equipment has been installed at this site. Signs have been posted to help you identify it. BEFORE fueling, please note the location of the following emergency equipment. NO SMOKING GASOLINE IS FLAMMABLE FIRE EXTINGUISHERS A RED EMERGENCY STOP BUTTON is on the card reader station panel. This will shut down the fuel pumps. AN EMERGENCY SHUT OFF SWITCH. This allows you to shut down the entire system from a location other than the fueling island. It is clearly identified with a sign. If a fire starts use the EFSO. A TELEPHONE or a fire alarm transmitting device. THE SITE OPERATOR S telephone number is posted at the site. If you need assistance or need to report a spill or problem, call this number. CONTAINERS Only approved containers may be filled. Approved containers must meet the following requirements: 1. CLEARLY MARKED with the name of the liquid. (NFPA No. 30A, Sec ) 3. A metal or *plastic safety can that holds 5 gallons or less. (NFPA 30, Sec ) *An approved plastic container is one that has been tested and listed to be in compliance with the requirements of ASTM F 852 or F 976, ANSI/UL 1313, or 49 CFR. 4. A metal drum, meeting DOT specifications that holds 60 gallons or less (NFPA 30, Sec 4.2.3) Procedures for fueling portable containers: 1. Portable containers up to 12 gallon must be placed on the ground before filling. DO NOT FILL PORTABLE CONTAIN- ERS WHILE THEY ARE IN A TRUNK, A BOAT, OR BED OF A PICKUP! (NFPA No. 30A, Sec ) 2. Do not use latch open devices when filling portable containers. OTHER PRECAUTIONS STOP YOUR ENGINE and put your vehicle in PARK or set your emergency brake. You MUST STOP your engine before fueling. Discharge static electricity before touching the nozzle. You must remain outside your vehicle and must attend the nozzle and be in full view of the nozzle while refueling. HOW TO BEGIN FUELING Insert access card into the card reader and remove it. Directions will appear on the screen of the card reader. Enter your security number. Press ENTER. (On a two card system, you will now enter the vehicle card using the same process). Activate the pump by entering the pump number. Press ENTER. Lift the nozzle from the pump and insert the nozzle deeply into the fuel tank. Activate the pump by lifting the lever on the side of the pump. Pull the trigger on the nozzle and begin to dispense fuel. The optimum nozzle setting for speed of delivery is between ½ and ¾ open. Faster delivery may result in a spill. If the nozzle is activated too quickly, a leak detector will automatically slow pumping to a trickle. If this happens, release the trigger on the nozzle and wait 20 seconds. Pull trigger back on and pumping should be normal. 2. Constructed of metal or approved plastic, have a tight closure, and be fitted with a spout or be so designed that the contents can be poured without spilling. (OFC NFPA ) Revised 10/26/15

8 FUELING COMPLETED The nozzle should click off when the tank is full. Shut the pump off by moving the lever on the pump down. Return the nozzle to its hanger. IN CASE OF FIRE, SPILL OR RELEASE 1. USE EMERGENCY PUMP SHUTOFF DANGERS OF DIESEL Diesel is combustible. May cause irritation to eyes. Avoid contact with eyes. Middle distillates (including diesel) have caused skin cancer and kidney damage in laboratory animals. Keep away from heat and flame. Use only in well ventilated locations. Avoid prolonged or repeated contact with skin. Wash thoroughly after handling. Keep head away from container when opening or dispensing. 2. CALL 911 TO REPORT THE ACCIDENT, or press the fire alarm if no phone is available. IN CASE OF SPILL OR RELEASE: CALL THE OPERATOR EMERGENCY NUMBER. WARNING: Driving away with the nozzle still in your vehicle can result in fire or spill, which could lead to extreme damage and serious injury. If you do drive off with the nozzle in the vehicle, follow the procedures below: 1. STOP VEHICLE. 2. TURN PUMP OFF. 3. PUT HOSE BACK ON PUMP IF POSSIBLE. 4. REPORT INCIDENT USING EMERGENCY NUMBER POSTED AT SITE. Advise of: Your Location Pump Number Date and Time Your Name and Telephone Number If other assistance is needed call the emergency number and report the problem. CAUTION! HAZARDOUS MATERIALS ALL FUELS ARE HAZARDOUS. Please read the following warning statements carefully. DANGERS OF GASOLINE Gasoline is extremely flammable. Harmful or fatal if swallowed. May be harmful if inhaled or absorbed through the skin. May cause irritation. May be harmful if absorbed through skin. Long term exposure to vapors has caused cancer in laboratory animals. Keep away from heat, sparks, and flame. Avoid breathing vapor. Use only in well ventilated locations. Avoid contact with eyes and prolonged contact with skin. Wash thoroughly after handling. Keep container closed. FOR USE AS MOTOR FUEL ONLY. FIRST AID PROCEDURES It is important that you follow these emergency and first aid procedures if you come into contact with gasoline and diesel fuel. EYES: Flush with water for 15 minutes. SKIN: Wash exposed areas with soap and water. INGESTION: DO NOT induce vomiting. May cause chemical pneumonitis. Call doctor. INHALATION: Should symptoms noted under physiological affects occur, remove to fresh air. If not breathing, apply artificial respiration. OTHER INSTRUCTIONS: Remove gasoline or diesel soaked clothing. PHYSIOLOGICAL EFFECTS: Acute Effects - Severe With Short Duration Gasoline AND Diesel: Causes slight to moderate eye irritation. Moderately irritating to the skin; causes redness, edema, or drying of the skin. Gasoline: May cause dizziness; irritation of eyes, nose and throat; vomiting; and bluish color of the skin. To the central nervous system, may cause contracted pupils, loss of reflexes, convulsions, seizures, sudden loss of consciousness, coma, and sudden death. Other symptoms are: Headaches, mental confusion and depression, flushing of the face, loss of appetite, nausea, slurred speech, and difficulty in swallowing. Diesel: Inhaling high concentrations of diesel vapors may cause drowsiness or unconsciousness (narcosis). Chronic Effects - Severe With Long Duration Recent studies with laboratory animals have shown that diesel and gasoline vapors cause kidney cancer in mice. IMPORTANT NOTICE The FIRE SAFETY TRAINING BROCHURE meets all requirements of Oregon Administrative Rules, Chapter 837, Division 20 and the Flammable Liquids Dispensing Regulations, ORS Please read and provide this information to all employees who are authorized to dispense fuel prior to dispensing. This brochure contains important information for those who operate nonretail fuel dispensing equipment. Revised 10/26/15

9 CARD ORDER FORM Account Name: Account Number: Contact: Phone: Select ALL cards that apply: CFN Pacific Pride Moro Wasco CFN CARDS: # Card Description PIN (5 digits) Products Limits Other (Name, Veh #, etc.) (Numeric only) (Dsl, Unl, Off Rd, etc) (ie.50 gal/da, etc) (i.e. M-F only, etc) PACIFIC PRIDE CARDS: (Can write same as above if applicable) # Card Description PIN (4 or 5 digits) Products Limits Other (Name, Veh #, etc.) (Numeric only) (Dsl, Unl, Off Rd, etc) (ie.50 gal/da, etc) (i.e. M-F only, etc) MORO / WASCO CARDS: (4 digit PIN s can not be selected, or changed for Moro and Wasco cards) # Card Description SITE Products Other (Name, Veh #, etc.) (Moro or Wasco) (Dsl, Unl, Off Rd, etc) (i.e. M-F only, etc) When cards are completed: Mail, Attn: Deliver on: for pickup: Call for pickup: Notes: To be completed by staff: Cards completed on: by: