Commercial Charge Account Application

Type of Account being applied for.

This application must be filled out completely and signed in both signature locations. Please allow processing time for credit history review.

Please select your serving store location. Your account, if approved, will work at all Genden Auto Parts store locations.

Applicant's Business Name*

Applicant's Type of Business (e.g., Auto Repair, Auto Body, Tree Service, Fleet Repair, etc.)*

Federal Tax ID#*

Please provide Expected Monthly Purchase Amount.*

State Sales Tax Permit #

If you are tax exempt or non-taxable please also fill out the State Tax form found on genden.com

Charge Sales Tax?*

If no please fill out the tax form found on our website that coincides with your sate and tax exemption. If the tax form is not filled out the account will be charged tax until we receive one.

Telephone Number*

Please enter a valid phone number.

Email Address *

Accounts Payable Email Address

Accounts Payable Contact Name*

First NameLast Name

Accounts Payable Contact Telephone Number*

Please enter a valid phone number.

Purchase Order Number Required*

Physical Ship to Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Billing or Mailing Address if different from above

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Checking Account #*

Bank Reference*

Name of Bank and Telephone #

Trade Reference - Business Name and Telephone Number*

TERMS

The above information is for the purpose of obtaining credit and is warranted to be true. I/We hereby authorize the creditor to whom this application is made, to investigate the references listed and to contact the Credit Bureau and any other sources pertaining to my/our credit and financial responsibility.

I/We, the undersigned, state that in making this request for credit, that I/We will assume all obligations for prompt payment. I/We understand that all indebtedness is due and payable on the 20th of the month following delivery and is considered past due by the 30th. All past due invoices are subject to finance charge (equal to the maximum allowable by state law) on outstanding past due balances as of the 30th of each month. I/We hereby authorize such a charge and agree to pay all finance charges the same as any other indebtedness.

I/we hereby undertstand and agree that should it become necassary to place this account in collection, I/We shall personally obligate myself/ourselves to pay all costs of collection, including collection agency fees, reasonable attorney's fees and cost/expenses of any legal proceedings.

The parties stipulate that this application and the agreement evidence thereby constitute a transaction involving interstate commerce. Except as otherwise provided in this provision, all claims, disputes or controversies of every kind and nature (weather biased in contract, tort, or statute) arising out of or related to this agreement or any other agreements, documents, instruments, or resides. The Arbitrator's shall be bound by Federal Rules of Evidence. All parties to the arbitration costs and expenses. The Arbitrator's findings, decision, and award shall be written, and shall be based on the law of the jurisdiction in which this agreement was excecuted. The decision of the arbitratot shall be final, binding, and enforceable in any court as though it were a decision on the merits after a trial on the merits: provided, however, the Arbitrator'sfindings, decision, and award shall be subject to judicial review as provided in 9 U.S.C. Section 10. The Arbitrator shall not consider the arbitration of class-wide and the parties hereby waive whatever right or position to have arbitration on a class-wide basis. the parties further stipulate that this arbitration clause shall be binding upan all individuals and entities who have interest, wewhether direct ot indirect, in agreement, its subject matter, and/or the relationship created herein.

The parties agree that the Arbitrator may award punitive damages only under circumstances where a court of competent jurisdiction could award such damages. However, in no event shall an award of damages exceed the lessor of (5) times the economic loss suffered by the party or $10000.00

I do hereby personally gaurentee the company' indebtedness to creditor, however arising, and including without limitation all indebtedness arising out of the sale of automotive parts and/or the furnishings of services by creditor.

I understand that this is a continuing gauranty covering all current and future advances of credit to the corporation, LLC, partnership or proprietorship, and that it is a gauranty of payment and not collection. I waive notice of this gauaranty and not collection. I waive notice of this gauranty by creditor and all extensions of credit to the corporation, LLC, partnership, or proprietorship. I further waive presentment and demand for payment of the debt, protest and notice of dishonor or default to any party with respect to the debt or any security therefore, and demand for payment.

The undersigned makes this application and gauaranty in his/her individual capacity and not as an officer or agent of corporation, LLC or partnership.

Printed Name*

First NameLast Name

Signature*

The undersigned hereby consent(s) to CARQUEST Auto Parts use of a non-business consumer credit report on the undersigned as a principal(s) proprietor(s) and/or gaurantor(s) in connection with the extension of business credit as contemplated by this credit application. The undersigned hereby authorize CARQUEST Auto Parts to utilize a consumer credit report on the undersigned from time to time in connection with the extension or continuation of the business credit represented by this credit application. The undersigned as (an) individual(s) hereby knowingly consent(s) to the use of such credit report consistent with the Federal Fair Credit Reporting Act as contained in 15 U.S.C. @ 1681 et seq.

Printed Name*

First NameLast Name

Signature*

I acknowledge that Genden Auto Parts invoices/statements will be delivered through E-mail and will comply with Email communication to maintain a charge account through Genden Auto Parts.

Initials*