12673 Steptoe Road P.O. Box 769 Roseland, LA 70456 Phone: 985-748-6993 Fax: 985-748-8365

ORGANIZATIONAL STRUCTURE: O CORPORATION 0 PARTNERSHIP 0 PROI'RIETORSHIP

PLEASE INCLUDE AUDITED COMPJNY FINANCIAL STATEMENTS FOR THE TWO PREVIOUS FISCAL YEAR-ENDS.

CREDIT APPLICATION TERM AGREEMENT

I CERTIFY THAT I AM AUTHORIZED TO MAKE THIS REQUEST ON BEHALF OF THIS COMPANY AND THAT I UNDERSTAND THE TERMS OF BALLARD'S PETROLEUM, LLC. ARE NET TEN (10) DAYS AND AGREE TO PAY ALL PURCHASES ACCORDING TO THESE TERMS. I FURTHER AGREE THAT THIS APPLICATION IS THE PROPERTY BALLARD'S PETROLEUM, LLC. AND THAT I AUTHORIZE BALLARD'S PETROLEUM, LLC. TO INVESTIGATE CREDIT AND FINANCIAL INFORMATION THROUGH ANY CREDIT BUREAU OR BY ANY OTHER REASONABLE MEANS

INCLUDING DIRECT CONTACT WITH PAST AND PRESENT CREDITORS.

ALL PAST-DUE ACCOUNTS ARE SUBJEST TO A FINANCE CHARGE THAT IS THE HIGHEST

ALLOWED BY STATE LAW, PLUS REASONABLE ATTORNEY'S FEES, AND COST OF SUIT IF THE PAST DUE ACCOUNT(S) IS PLACED FOR COLLECTION.

CREDIT ACCOUNT AGREEMENT AND TERMS

The applicant reflected above acknowledges and agrees to the following terms and conditions of sale: 1. It is understood and agreed that the undersigned specifically consents to Ballard's Petroleum, LLC. investigating the credit history for the purpose of extending credit. 2. If credit is extended, the undersigned acknowledges that Ballard's Petroleum, LLC.'s credit terms are payment in full, net ten (10) days from the date of invoice. 3. In the event the undersigned fails to timely pay any invoice, the undersigned agrees to pay a late fee and/or finance charges to Ballard's Petroleum, LLC. on such delinquent invoice until same is fully paid. The applicant fully understands and agrees that these charges are levied by the seller to reimburse him for the additional cost of carrying his delinquent account. 4. Ballard's Petroleum, LLC. reserves the right to discontinue shipments to said applicant if account is delinquent and until such condition is corrected. 5. If it becomes necessary to retain legal or professional assistance to collect any indebtedness on the account, the applicant agrees to pay the fees of all legal and professional services, including any court costs.

In consideration to Ballard's Petroleum, LLC. for extending credit for products and services to the business or individual listed below, the undersigned individual hereby personally guarantees unconditionally and irrevocably the full and prompt payment of any sums nor or hereafter owed to Ballard's Petroleum, LLC. whether sums are due under open account, contract or other. This is a continuing guaranty and obligations arising hereunder shall not be affected by any change in terms of indebtedness, the extension of credit beyond amounts specified herein, a change in the term or time for payment, a change in the form of indebtedness or the acceptance of security of collateral. Ballard's Petroleum, LLC. shall not be required to exhaust any remedies against applicant prior to exercising rights granted hereby. This is a guaranty of payment, not of collection, and the undersigned further waives any right to require any action be brought against the applicant or any other person or security. It is understood that this guarantee is unconditional without limit or reserve, and that the guarantor agrees to pay all costs as well as attorney fees should the indebtedness have to be referred to an attorney for collection. This guarantee shall continue in force until notice in writing, sent by certified mail, return receipt requested, is received by Ballard's Petroleum, LLC. Said notice shall specify the date on which this guarantee is to be terminated, and the said date shall not to be less than ten (10) days after such notice is received. Such termination shall in no way release the undersigned from any sum or debt incurred prior to such termination.

Check One (1) and Enter Your Details

- Recurring Charge - You authorize regularly scheduled charges to your credit card or bank account. A receipt for each payment will be provided to you and the charge will appear on your credit card or bank statement.

, authorize Ballard's Petroleum, LLC. to charge my

Credit Card or Bank Account below ten days from date of invoice.

- One (1) Time Charge - Sign and complete this form to authorize the merchant below to make a one-time charge to your credit card or bank account listed below. By signing this form, you give us permission to debit your account for the amount indicated on the invoice, on or after the invoice date. This is permission for a single transaction only and does not provide authorization for any additional unrelated debits or credits to your account. , authorize Ballard's Petroleum, LLC. to charge my (Full Name)

credit card or bank account indicated below on or after date of invoice.

Credit Card (There is a 3% charge on all transactions for use of a credit card)

I understand that this authorization will remain in effect until I cancel it in writing, and I agree to notify the merchant in writing of any changes in my account information or termination of this authorization at least 15 days prior to the next billing date. If the above noted payment dates fall on a weekend or holiday, I understand that the payments may be executed on the next business day. For ACH debits to my checking/savings account, I understand that because these are electronic transactions, these funds may be withdrawn from my account as soon as the above noted periodic transaction dates. In the case of an ACH Transaction being rejected for Non-Sufficient Funds (NSF) I understand that the merchant may at its discretion attempt to process the charge again within 30 days and agree to an additional $25.00 charge for each attempt returned NSF. I acknowledge that the origination of ACH transactions to my account must comply with the provisions of U.S. law. I certify that I am an authorized user of this credit card/bank account and will not dispute these scheduled transactions with my bank or credit card company; so long as the transactions correspond to the terms indicated in this authorization form.