Application for Pre-Paid Courtesy Account

COD Transactions Only!
New Customer     Machinery Power

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Wheeler Sales Professional:  Industry Code:
Applicant Name:
Trade Name:
Street Address:
Billing Address:     

Business#()-   Mobile/Pager#()-   Fax#()-   Email:

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Contact Name:   Title:    Phone#()-  
Business Organization: Individual   Partnership   Corporation   LLC   Other  
Type of Business:
Date Started: Time as Current Owner:
Sales Tax Exempt: Yes   No   (if yes please attach form below )

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AGREEMENT FOR CASH ACCOUNT ACCOMODATIONS AND RELEASE OF INFORMATION

By signing below, Applicant agrees to all of the following terms: (1) Customer shall pay ALL invoices at the Point of Sale for Purchases, Rentals, and/or Service. (2) All sums not paid as indicated in item one shall be considered past due and shall bear a service charge of 2% per month. (3) Customer agrees to pay all attorney fees and costs, as well as the cost of investigators and collection agencies, if any or part of this account is past due, whether or not court action is taken or a judgment is rendered. (4) This agreement shall be considered under the laws of the State of Utah. (5) If legal action is brought to enforce this agreement, Salt Lake City, Utah shall be the exclusive jurisdiction and legal venue for said action. (6) Customer agrees to and shall pay Dealer a $20.00 service charge on each dishonored check. (7) Dealer has the right to file a Preliminary Notice on any project to which equipment has been supplied, and Customer agrees to and shall provide complete Preliminary Notice information when requested by Dealer and will at all times keep Dealer informs as to the location of Dealer's equipment. (8) Dealer's acceptance of this Cash Application constitutes acceptance by the Customer of the terms and conditions of this agreement. (9) All transactions made hereunder shall be governed by the foregoing terms and conditions as well as any terms or conditions on Dealer's quotation, agreements, rental agreements and/or invoices.

Customer further agrees that the Dealer may at Dealer's sole discretion accept, utilize and rely upon a facsimile copy, electronic copy, or photocopy of this agreement and the Continuing Personal Guaranty, in lieu of any original document. Customer acknowledges that by transmitting a facsimile copy, electronic copy or photocopy of this document to the dealer, Customer and the Guarantor (if applicable), agree to be bound by the terms and conditions contained in this document to the same extent as if an original were transmitted to Dealer. Applicant, and Guarantor (if applicable), consent to Dealer's use of this document and waive any right to object to the use of a copy in place of the original and any right to require Dealer to subsequently produce an original document.

The above information is furnished for the sole purpose of obtaining a Cash account. We hereby authorize Wheeler Machinery Co. to verify information from whatever source it deems appropriate to determine my/our credit and financial responsibility. Applicant and each person signing below, and on the Continuing Personal Guaranty if applicable, warrants that the information provided herein or in connection with this application is true and correct and authorizes the release of such information to CAT Financial, Caterpillar Dealers and/or any party which may provide credit to Applicant.

Applicant Name: (Required) Title:
S.S.#
Drivers License # State: <-- Select --> Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Date:
Accept

Pursuant to Utah Code Ann. § 46-4-105, and other applicable laws, the parties to this credit application hereby agree to conduct this transaction by electronic means and applicant agrees to the terms of this credit application as evidenced by his/her electronic signature above.