Interstate Billing Service

CREDIT APPLICATION DISCLOSURE AGREEMENT

The above information is given for the purpose of obtaining credit. The applicant, by and through its duly authorized officer signed below, in addition to the guarantors named below (collectively “I” or “We”) warrant that all of the information is true. We affirm that we are financially able to meet our obligations, and will remit in accordance with the invoice terms. I/We hereby direct all of the creditors named in the application to release to Interstate Billing Service, Inc. (IBS), Bank Independent (BI), or its representatives, such information with regard to my/our financial condition as may be reasonably requested by IBS/BI. I/We authorize IBS/BI to obtain a consumer credit report on my/our personal credit history if necessary, in accordance with the Federal Fair Credit Reporting Act, and to use this report in making decisions concerning my/our credit worthiness for a 30-day account. I/We understand a personal guaranty may be required. If I/We refuse to sign this application, I/We will not be considered as a candidate for credit with IBS/BI. A credit guideline may be established at the discretion of IBS/BI. Applicant agrees to pay any collection costs incurred to collect any unpaid balance, including interest thereon, as allowed by state law, and any related attorney’s fees. I/We agree not to assert any claims or defenses, including the right of offset against the accounts/invoices purchased by and/or assigned to IBS/BI from any dealer. My/Our use of this credit constitutes acknowledgement of and agreement to the terms and conditions set forth by IBS/BI, as such terms and conditions may change from time to time in the sole discretion of IBS/BI. This agreement shall be governed by and construed according to the laws of the State of Alabama. I/We submit to the jurisdiction of any Alabama State or Federal Court sitting in the Northern District of Alabama over any action arising hereunder and agree that all claims will be brought in such Alabama State or Federal Court. I/We further waive any objection on the basis of forum non-conveniens. If this application is approved, your account has been assigned to and/or purchased by IBS/BI.

Make checks payable to the dealer(s). Please mail all payments c/o Interstate Billing Service, PO Box 2208, Decatur, AL 35609-2208. Payment terms will be reflected on the monthly statement and/or invoice. If your business should sell or close, it is the applicants’ responsibility to advise IBS/BI immediately.