Commercial Financing

CREDIT APPLICATION

Date*

Company Name*

Mailing Address*

Address Line 1

Address Line 2

City

State

ZIP Code

County*

Phone Number*

Fax Number*

Email*

Dun & Bradstreet #

Federal ID #*

State ID #

Tax Exemption Form

No File Chosen

File uploads may not work on some mobile devices.

Is your purchase tax exempt? ***If YES, upload a copy of your tax exemption form.

PO Numbers:*

Yes No

Do you require Purchase Order Numbers?

Invoice & Statement Delivery*

Email Fax Mail

What is your preferred method to receive invoices for payment?

Invoice & Statement Information*

Please enter the email, fax number, or mailing address for invoices and statements to be sent to.

Store #*

Black's Tire Location you do business with.

Salesman

Your Black's Tire Salesman. If you do not have a salesman, one will be assigned to contact you.

Accounts Payable Information

Contact Person(s)*

Phone #*

Fax #*

Credit Line Requested*

*** If credit limit requested exceeds $5,000, a Personal Guarantee and Owner Information must be filled out! ***

Owner Information (Must be Completed if requested credit line exceeds $5000)

***For owner operator business requesting over $5000.00 Owner
Information must be filled out.***

In consideration of Black’s Tire Service extending credit to the guarantor, the “Guarantor(s)” personally and unconditionally guarantees to Black’s Tire Service, Inc. the
payment of all the Applicant’s present and future obligations. The “Guarantor(s)” also agrees to pay on Demand all sums due or that become due to Black’s Tire
Service, Inc. from the Applicant and all losses, costs, attorneys fees, or sums due or that become due to Black’s Tire Service, Inc. from the Applicant and all losses,
costs, attorneys fees or expenses which may be incurred by Black’s Tire Service, Inc. by reason of the Applicant’s default. Black’s Tire Service, Inc. may proceed to
collect all sums that are or that become due to Black’s Tire Service or any part thereof, from the undersigned or any of them without first exercising any of its rights
against the Applicant or any collateral before enforcing the obligations of the undersigned or any of the hereunder. If Applicant is not a corporation or a limited liability
company at the time this Guaranty is executed by Applicant subsequently incorporates or forms a LLC, with or without the knowledge or consent of Black’s Tire
Service, Inc., the undersigned shall be jointly and severally liable to Black’s Tire Service, Inc. for any indebtedness incurred by or transferred to such corporation or
LLC. No termination of this Guaranty shall be affected by the death of any or all of us. This Guaranty may not be terminated except by notice sent to Black’s Tire
Service, Inc. by registered mail naming a termination date effective not less than 30 days after receipt of such notice. No termination shall affect the indebtedness and
obligations arising from agreements or arrangements made prior to an effective termination date. Each of us waives notice of acceptance hereof and waives
presentment, demand, notice or dishonor, protect, notice of protest and nonpayment as to any note or obligation signed, accepted, endorsed, or assigned to Black’s
Tire Service, Inc. by the Applicant, and all exemptions and any other demands and notice required by law. The undersigned further agrees that any legal action
hereunder shall be conducted in Columbus County, North Carolina. Guarantors joint and several obligations on the part of the undersigned and shall bind our
respective heirs, administrators, personal representatives, successors, and assigns, and shall insure to Black’s Tire Service, Inc. successors and assigns including,
but not limited to, any part to which Black’s Tire Service, Inc. may assign any item or account. All of Black’s Tire Service, Inc. rights are cumulative and not alternative.

Accept Personal Guarantee Terms*

I have read and accept the credit terms listed above.

Owner 1

First Name

Last Name

Address

Address Line 1

Address Line 2

City

State

ZIP Code

SS#

Owner 1 Signature

[clear]

Use your mouse or finger to draw your signature above

Owner 2

First Name

Last Name

Address

Address Line 1

Address Line 2

City

State

ZIP Code

SS#

Owner 2 Signature

[clear]

Use your mouse or finger to draw your signature above

Credit References

Reference #1 Name:*

Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Reference #2 Name:

Address

Address Line 1

Address Line 2

City

State

ZIP Code

Reference #3 Name:

Address

Address Line 1

Address Line 2

City

State

ZIP Code

Please be advised that all purchases are due on the tenth of the month following purchase. A service charge of 1.5 % per month will be added to past due balances. Please be advised that any account that is not paid by the 20th will be considered delinquent and will be placed on a cash only basis.

Please be advised that any account that is not paid by the 20th will be considered delinquent and will be placed on a cash only
basis.

Accept Credit Terms*

I have read and accept the credit terms listed above.

I give permission to Black’s Tire to obtain credit information from the above references or form a credit bureau.

Name*

First Name

Last Name

Title*

Signature*

[clear]

Use your mouse or finger to draw your signature above

Date*

REVIEWED BY:

DATE:

STATUS

APPROVED DECLINED

Credit Limit $:

REMARKS

Location/Store #

Salesman

Matrix

Goodyear Non-sig #

Mfg Program

Web User Name

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