Please read the following and sign.
1.I apply for a cardlock card(s) (the “Card”) of the local or system-wide type, as indicated above, for the purchase of petroleum fuel in the CO-OP Cardlock System.
2.I agree to complete and sign the necessary account application form.
3.I hereby confirm that I have been provided a copy of the Cardlock User Agreement (Form 910) and, if my application herein is accepted, I unequivocally confirm that I accept all terms and conditions contained therein. In particular, I acknowledge that I have carefully read and reviewed paragraph 6 of the cardlock user agreement and fully and unequivocally confirm that I shall be fully responsible for all charges incurred as against my cardlock card regardless of whether the charges were incurred without my consent or knowledge.