Credit Application Agreement

Definitions: “I” means each and every applicant and co-applicant signing below who is requesting a Personal Charge Account (the “Account”). If this application is approved, each applicant and co-applicant signing below will be bound individually and together to repay all amounts owed on the Account.

“You” means Greenbrier Medical Arts Pharmacy, Inc., Union Pharmacy, or Western Greenbrier Pharmacy, Inc. (the merchant from whom I am requesting the Account.)

Account: I request that you establish an Account for me which will permit me to charge purchases from you and to be billed monthly for purchases charged to my Account, not to exceed the Maximum Credit which you approve (which you may change from time to time).

Application: I understand that Universal Charge Accounts, Inc., PO Box 111323, Pittsburgh, PA 15238 (“Universal Charge Accounts”), may assist you in reviewing and processing my application for the Account, and may obtain consumer reports (credit reports) about me for this purpose. I also understand that Universal Charge Accounts may communicate its recommendation or decision to you about my application for the Account. If you do not open the requested Account, you and/or Universal Charge Accounts will send the applicant a notice listing the primary reason(s) for declining my application for the Account (and I understand the primary reason(s) could relate to a co-applicant’s credit history and/or credit report).

Future Credit Reports: If you open the requested Account, I understand that you and/or Universal Charge Accounts may obtain consumer reports (credit reports) about me in connection with review or collection of the Account or for other lawful purposes.

Credit, Employment and Other Information: You and Universal Charge Accounts may contact the references in my application, and obtain additional credit and employment information about me from third parties (including without limitation credit reporting agencies) to review and process my application for the Account, and (if you open the requested Account) in connection with review or collection of the Account, to the extent allowed by law. You and Universal Charge Accounts may answer questions from third parties about this application, the Account and my payment history, to the extent allowed by law. You and Universal Charge Accounts may contact me about this application and the Account at any address or telephone number I give you in connection with this application or the Account.

General: Everything I have stated in this application is true and correct to the best of my knowledge. I understand you and Universal Charge Accounts may keep this application regardless of whether you open the requested Account.