GSC ENTERPRISES, INC.

DBA GROCERY SUPPLY COMPANY

P. O. BOX 638 SULPHUR SPRINGS, TEXAS 75483

Customer Application

Phone: (903)-885-7621

E-FORM VER. CA032010

Account Number:
New Account Reinstate/Update Change of Ownership

CUSTOMER BUSINESS NAME: (DBA): BUSINESS PHONE: (AREA CODE) NUMBER

CORPORATION, LLC, LLP, (etc.) NAME: COMPANY E-MAIL ADDRESS: E-MAIL ADDRESS:

DELIVERY / SHIP TO ADDRESS: CITY: STATE AND ZIP: COUNTY: FAX PHONE: (AREA CODE) NUMBER:

MAILING / BILL TO ADDRESS: CITY: STATE AND ZIP: COUNTY: ALTERNATE / CELL PHONE: (AREA CODE) NUMBER

1. NAME OF OWNER; OFFICER(S); PARTNER(S): TITLE: HOME PHONE: (AREA CODE) NUMBER:
O

W HOME ADDRESS: CITY: STATE AND ZIP: SOCIAL SECURITY NUMBER:
N

E 2. NAME OF OWNER; OFFICER(S); PARTNER(S): TITLE: HOME PHONE: (AREA CODE) NUMBER:
R
S HOME ADDRESS: CITY: STATE AND ZIP: SOCIAL SECURITY NUMBER:

BUSINESS TYPE: ** Current Financial Statement
CONTACT PERSON FOR PAYMENT INFORMATION:
Sole Proprietor Partnership Corporation** Required for Corporations

STORE FACILITIES: ANY PRIOR BANKRUPTCY? PHONE: (AREA CODE) NUMBER & EXTENSION:
Own Lease Yes No Year

IF CHAIN GROUP, HOW MANY STORES? IS INVENTORY MORTGAGED? GROSS WEEKLY SALES? YEARS IN BUSINESS? STORE HOURS:
Yes No Open: Close:
ARE YOU AN AGENT FOR FIDELITY EXPRESS BILL PAYMENT AND/OR MONEY ORDERS?:
Yes No Bill Payment Money Orders

TRADE REFERENCES
Please include current supplier and account number

NAME: ACCOUNT NUMBER:

ADDRESS: PHONE: (AREA CODE) NUMBER:

CITY: STATE: ZIP:

NAME: ACCOUNT NUMBER:

ADDRESS: PHONE: (AREA CODE) NUMBER:

CITY: STATE: ZIP:

BANKING INFORMATION

BANK NAME: BANK ACCOUNT NUMBER:

BANK ADDRESS: PHONE: (AREA CODE) NUMBER:

CITY: STATE: ZIP: CONTACT PERSON:

I acknowledge and agree to the following: (1) I understand that this document is for application purposes only, but upon approval by GSC Enterprises, Inc. dba Grocery Supply Company (GSC) shall become the binding
Agreement between the parties. (2) That interest not to exceed the maximum rate the law allows will be charged on all past due balances that exceed the terms specified by GSC; (3) That in the event of non-payment or
insufficient payment, of my account, that GSC will immediately stop shipping; and if the account is referred to an attorney or collection agency, to pay all cost of collection including reasonable attorney's fees; (4) When paying
GSC, if your payment is dishonored or returned for any reason, you expressly authorize GSC to electronically debit your account for the amounts of the payment plus a processing fee not to exceed $25.00. Your initiation of
payment for goods received is acceptance of this agreement and its terms. In the event you should have a draft returned, GSC will require a Cashier's Check or Wire Transfer to cover the returned item. Until the guaranteed funds
are received in our office, the account is placed on hold and orders are not processed. GSC reserves the right to modify the terms of the account in the event of a returned payment.(5) That if the type of ownership, or any of its
principals, of the business changes from that listed above, I will still be held liable for all debts and obligations incurred in connection with my request. I will notify GSC by certified mail of any change(s) to the ownership or
business. (6) That if additional stores or locations are added at my request, the terms and obligations of this agreement will extend to those accounts or additional locations. (7) That only Corporate Officers, Division Managers, or the
Credit Managers of GSC have the authority to modify in writing the terms of this agreement. (8) That Purchaser's credit terms will be stated on the GSC invoice. Purchaser fully understands that any time Purchaser is not within
credit terms, all credit privileges will be null and void and terms will revert to payment prior to or at time of delivery, at GSC discretion, and interest will be accrued on all unpaid balances; (9) I understand that the above
information is given for the purpose of obtaining credit information and I certify that the above information is complete and accurate as of the date of this application. (10) That an electronic version of this document shall
suffice as an original and shall have the same binding effects as an original. This contract may be executed by any electronic means and with electronical signature of the parties, and may be relied upon as if the original had been received.

I authorize you to contact these references and for them to release any financial information you require. I agree that this contract is performable and all bills payable in connection therewith in Sulphur Springs, Hopkins
County, Texas. This contract shall be governed by the laws of the State of Texas. I agree and consent that the court of the State of Texas for Hopkins County or any Federal District Court having jurisdiction in that county shall have
jurisdiction and shall be the proper location for the determination of any disputes arising under this contract and any amounts due. I waive trial by jury and any action between us.

ELECTRONIC OR CUSTOMER SIGNATURE X __________________________________________________ DATE: _________________

Designate Title if Authorized Corporate Officer
REVISED 7/2013 PAGE 1 OF 4
 CERTIFICATE OF RESALE, LEASING OR RENTING PROPERTY
TANGIBLE PERSONAL PROPERTY

I HEREBY CERTIFY: That I hold Limited Sales Tax Permit # _________________________________________________________________

issued pursuant to the Limited Sales, Excise, and Use Tax Law, and that the tangible personal property described below, or
which is shown in the attached order of invoice, which is made a part hereof, which I will purchase from GSC Enterprises, Inc.
dba Grocery Supply Company (GSC), Sulphur Springs, Texas, will be re-sold, rented or leased by me in the form of tangible
personal property; however, if I make any use of the tangible personal property other than retention, demonstration or display
while holding it for sale, lease, or rental in the regular course of business, the use shall be taxable to me as of the time when the
tangible personal property is first used, and the sales price of the property to me shall be deemed the measure of the tax.

BUSINESS NAME:

SIGNATURE: X DATE:

RETAIL CIGARETTE AND TOBACCO PRODUCTS PERMIT # EXPIRATION DATE:

THE STATE OF TEXAS

COUNTY OF HOPKINS

UNCONDITIONAL GUARANTY BY JOINT AND SEVERAL GUARANTORS

To: GSC Enterprises, Inc. dba Grocery Supply Company, Sulphur Springs, Hopkins County, Texas

1) The Guarantors, jointly and severally, unconditionally guarantee and promise to pay GSC Enterprises, Inc. dba Grocery
Supply Company (GSC) or any its assigns any and all indebtedness incurred on or after the date of this Application as shown on
page 1 by customer, as herein noted, by reason of the purchase from GSC of groceries and other goods, materials and services,
under the terms and conditions including payment of and rate of interest, all as provided in this entire Customer Application,
in addition to any fees or costs associated with the collection of this account, including reasonable attorney's fees.

2) The guaranty shall terminate on delivery to GSC, at Sulphur Springs, Hopkins County, Texas, a written notice of termination
effective as to any and all indebtedness incurred or created by customer from and after such delivery of notice of terminations.

3) This Guaranty is continuing until terminated and shall cover all future indebtedness, including indebtedness arising under
successive transactions that shall either continue the liability of customer or from time to time renew it after it has been
satisfied.

4) This Contract of Guaranty is performable and payable in Sulphur Springs, Hopkins County, Texas. This guaranty shall be
governed by the laws of the State of Texas. I agree and consent that the Court of the State of Texas for Hopkins County or any
Federal District Court having jurisdiction in that county shall have jurisdiction and shall be the proper location for the determi-
nation of any disputes arising under this guaranty and any amounts due. I waive trial by jury in any action between us. If this
is a corporate guaranty, it is authorized by the Board of Directors of the guaranteeing corporation. If it is a partnership
guaranty, it is authorized under the partnership agreement.

5) Guarantor(s) hereby authorizes GSC Enterprises, Inc., to conduct individual credit investigations.

6) Guarantor(s) agree that an electronic version of this guaranty shall suffice and have the same binding effect as an original
signature.

Dated the date of this Customer Application as shown on page 1.

GUARANTORS:
X
INDIVIDUALLY PRINT NAME

X
INDIVIDUALLY PRINT NAME

X
INDIVIDUALLY PRINT NAME

A current financial statement is requested for all multi-store accounts, and by all accounts requesting credit terms. All
documents will be kept in strict confidence, and should be forwarded directly to the GSC Credit Department. Any commu-
nications concerning disputed debts tendered as full satisfaction of a debt are to be sent to the following designated office and
address: Grocery Supply Company; Credit Department; Attn: Credit Manager; P. O. Box 638, Sulphur Springs, TX 75483-0638

INITIAL

REVISED 7/2013 PAGE 2 OF 4

 AUTHORIZATION FOR
ELECTRONIC TRANSFER OF FUNDS

The Undersigned customer hereby authorizes GSC Enterprises, Inc., dba Grocery Supply Company (GSC) to originate
debit/credit entries via electronic funds transfer to the customers designating checking account indicated below. The bank
indicated below agrees to accepts and debit/credit the amount of such entries to the customers account. The customer agrees
to all terms and conditions of sale established by GSC. This contract is performable in Hopkins County, Texas.

Entries (debit/credit) will be initiated by GSC through GSCs bank for credit to GSC, effective upon acceptance by GSC and GSCs
bank, and shall become the means of payment to GSC by the customer.

The customer may cancel this authority by giving seven days written notice to GSC and the customers bank. Once GSC and the
customers bank have each received written notifications from the customer of the termination of such authority, GSC shall
advise the customer of the effective date of cancellation.

The customer understands that drafts (transfer requests) will be honored only if sufficient funds are available in the designated
checking account. This agreement will become effective as soon as necessary banking network pre-authorizations are verified
and operational.

The following information is supplied by customer for the benefit of GSC to effectuate the authorization for electronic transfer
of funds.

NOTE: Please provide GSC with an attached voided check.

BANK NAME: PHONE: (AREA CODE) NUMBER:

ADDRESS:

CITY: STATE: ZIP:

BANK ABA#: BANK ACCOUNT NUMBER:

ACCOUNT NAME (As shown on Bank Account):

ADDRESS: PHONE: (AREA CODE) NUMBER:

CITY: STATE: ZIP:

E-MAIL ADDRESS FOR EFT NOTIFICATION: DATE:

AP CONTRACT NAME (print): TITLE: GSC CUSTOMER NUMBER:

ADDRESS: PHONE: (AREA CODE) NUMBER:

CITY: STATE: ZIP:

Please indicate your acceptance of the terms and conditions of this authorization in the space indicated below.

By: By:
GSC AUTHORIZED REPRESENTATIVE CUSTOMER AUTHORIZED REPRESENTATIVE

TITLE:

DATE:

REVISED 7/2013 PAGE 3 OF 4

 SALES WORKSHEET ACCOUNT SET-UP INFORMATION
(FOR GSC INTERNAL USE ONLY TO BE COMPLETED BY SALESPERSON)

BUSINESS TYPE: Convenience Store Wholesale Distributor Cigarette/Tobacco Store

Other

Current/Previous Customer :Account Name, Number, or Root Number -

ACCOUNT
INFORMATION: Co-op Group: Account Name and Account Number -

Is this an Opening Stock Order? Yes No If yes, give Estimated Amount: $

First Delivery: Average Weekly Purchases: $

EFT/ACH A P C Q S N (circle or click one. Include authorization form and voided check)

PAY METHOD: CREDIT CARD: (Include authorization form)

SALES AND ACCOUNT SET UP INFORMATION:

Grocery(only): RetailID:

Salesperson Number: CatalogType:

CandyZone: MinimumOrder:

Minimum M/U: Retail Rnd 5/9:

Grocery and Service: Weekly Bulletin:

SERVICE MERCHANDISE PROGRAM: SM Rep Number:

Yes Full Service Flat Fee:

No Order Write Markup Plan:

ADDITIONAL INFORMATION:

Salesperson: Date:

Account Set Up: Date:

TO BE COMPLETED BY GSC CREDIT DEPARTMENT

ACCOUNT REVIEW:

Approved: Terms: Credit /Order Limit:

Refused: Reason:

Credit Manager: Date:

REVISED 7/2013 PAGE 4 OF 4