Nustar Account Application

Has the Company ever done, or is the Company doing, business under another name and/or in a different State?

If so, please list the name and address:

Has any officer or director of the Company ever done business using another entity or name and/or in a different State?

If so, please list the name and address:

Has any owner of the Company ever done, or is any officer of director doing business using another entity or name and/or in a different State?

If so, please list the name and address:

Has the Company filed bankruptcy, been the subject of an involuntary bankruptcy proceeding, filed an assignment for the benefit of creditors, or had a receiver or trustee appointed to manage its assets within the last 7 years?

If so, in what year and in what state?

Has any officer of the Company filed bankruptcy, been the subject of an involuntary bankruptcy proceeding, or had a receiver or trustee appointed to manage his/her assets within the last 7 years?

If so, in what year and in what state?

Has any owner of the Company filed bankruptcy, been the subject of an involuntary bankruptcy proceeding, or had a receiver or trustee appointed to manage its assets within the last 7 years?

If so, in what year and in what state?

List all lawsuits (including parties, venue, and status) brought against the Company in the last 7 years

The person(s) signing below has read the Application for Business Credit and Agreement (the “Agreement”) and agrees that the Agreement is subject to the attached terms and conditions, which are incorporated, and an integral part of this Agreement. The person(s) signing below warrants and represents that he/she has the authority to enter into this Agreement on behalf of the Company. The signature(s) below constitute the acknowledgment of receipt of the terms and conditions, and that the Company is bound to same even if such is not returned to Nustar with the signed Agreement.

Signature

Title

Printed Name

Date of Signature

Nustar Account Application

Section I – Contact Information

Section II – Owners and/or Officers

Section III – Trade References

Section IV – Prior Business Activities