Offshore Systems, Inc. / Aleutian Fuel Services

Offshore Systems, Inc. / Aleutian Fuel Services

Confidential Credit Application for Commercial / Vessel Accounts

Please complete, sign, and return this form to: Offshore Systems, Inc. Corporate Office, 12019 - 76th Place N.E., Kirkland, WA 98034.

For questions, please call 425-828-6434.

For the purpose of obtaining credit from Offshore Systems, Inc. / Aleutian Fuel Services and its affiliates, the following statements are made intending that they will be relied on as correct. Credit will not be granted without the completion of this application and an authorized signature.

Terms

Net thirty (30) days from invoice date and overdue thereafter unless stated otherwise. 1.5% interest charge per month on past due accounts.

Company Information

Company Name:

Billing Street Address:

Billing City, State, Zip:

Physical Street Address:

Physical City, State, Zip:

Phone Number:Fax Number:

Type of Business:

Home Port:

Name of Vessel:

Official Vessel Number:

Form of Organization: Sole Proprietorship Partnership Corporation:Date of Incorporation: State:

Trade References

Company Reference (1):

Account Number:

Address, City State Zip:

Contact Name:Phone Number:

Company Reference (2):

Account Number:

Address, City State Zip:

Contact Name:Phone Number:

Company Reference (3):

Account Number:

Address, City State Zip:

Contact Name:Phone Number:

Bank References

Bank Name:

Account Number:

Address, City State Zip:

Contact Name:Phone Number:

Have either you as signatory or the business entity ever declared bankruptcy? Yes (if yes, please provide details below) No

As authorized and responsible party forfor the purpose of obtaining credit from Offshore Systems, Inc. / Aleutian Fuel Services, the undersigned has read, understands and agrees to the following:

To be personally and individually liable to Offshore Systems, Inc. / Aleutian Fuel Services for all debts incurred by the corporation, partnership, or other represented entity.
To pay all invoices within thirty (30) days of invoice. If the debts incurred by the business entity are not paid within the specific thirty (30) day period, there is immediate personal and individual obligation to make such payments.
To give thirty (30) days notice of cancellation of this guarantee in writing and that Offshore Systems, Inc. / Aleutian Fuel Services may cancel credit privileges to the business entity if any one signatory withdraws their guarantee.
To pay interest at the rate of 1.5% per month on all charges outstanding for thirty-one (31) days or longer; provided, however, that is such rate of interest is prohibited by applicable law, then the rate of interest will be the highest rate permitted by such law.
To pay reasonable court and attorney fees in the event that collection by law becomes necessary.
I/We further understand that only in consideration of signing this agreement of personal liability has credit been extended to the business entity.

Partnership / Sole Proprietorship Acceptance

Name (1):Title:

Home AddressCity, State, Zip:

Social Security Number:

Signature:Date:

Name (2):Title:

Home AddressCity, State, Zip:

Social Security Number:

Signature:Date:

Corporate Acceptance

Name (1):Title:

Signature:Date:

Name (2):Title:

Signature:Date:

Corporate Officers Personal Guarantee Endorsement

Name (1):Title:

Home AddressCity, State, Zip:

Social Security Number:

Signature:Date:

Name (2):Title:

Home AddressCity, State, Zip:

Social Security Number:

Signature:Date:

I do hereby certify that this information provided within is correct.

Signature:Date:

Name (2):Title:

For Office Use Only

Checked by: Date:

Credit Manager Approval:Date:

Credit Limit:Date:

Confidential Credit Application - Page 1 of 2

Form 0100 Rev.051209