Evergreen FS, Inc.

The above information is for the purpose of obtaining credit terms and is warranted to be true. I/we agree that EVERGREEN FS, Inc. can and will rely on the information set forth by me/us in this application and that EVERGREEN FS, Inc. is reasonable in doing so. I/we authorize EVERGREEN FS, Inc. to investigate the references listed pertaining to my/our creditor worthiness and financial responsibility. I/we further authorize EVERGREEN FS, Inc. to request consumer reports from consumer reporting agencies to consider this application and to review or collect the account. I/we agree to abide by the terms and conditions set forth in this application and in EVERGREEN FS, Inc.'s Credit Policy, receipt of which is hereby acknowledged. I/we understand and agree that interest at the rate of 24% per annum, or the maximum amount allowed by law, will be assessed on any outstanding balance owed, if not paid according to the terms as stated. Any legal proceedings arising out of any contract made our dealing between the parties is to be processed and submitted to a court in the state of Illinois and be governed by the laws of Illinois. I/we hereby agree to venue in McLean County, Illinois for any action arising out of this agreement. I/we agree that, in the event of legal action against me/us by EVERGREEN FS, Inc. as a result of my/our failing to fulfill any duty or and/or obligation to EVERGREEN FS, Inc., I/will pay any costs, including attorney's fees, incurred by EVERGREEN FS, Inc. in connection with said legal action. By signing below, I/we attest to receiving "Duty to Warn" literature concerning (Liquid Petroleum) LP Gas.