CREDIT APPLICATION
Name on Account __________________________________________________________
Address __________________________________________________________________
City_____________________________________ State_______ Zip_________________
Telephone______________________________ Contact ___________________________
Fax _______________________ Type of Business________________________________
Type of Entity: Proprietorship ____ Partnership ____ Corporation _____ Other _____
If Incorporated: State of Incorporation ________ Year of Incorporation ____________
Date Business Established ________________________
Key Management Members and Owners
Title
Ownership %
___________________________________
______________________
____________
___________________________________
______________________
____________
___________________________________
______________________
____________
Financial ______________________________ Address ___________________________
City ____________________________ State ___________ Zip______________________
Phone (____) _______________ Officer ____________________ Account #___________
Trade References List 2 Major References
Name
Phone Number
Fax Number
_____________________________
__________________
_____________________
_____________________________
__________________
_____________________
The above information is provided to Kwik Stop for the purpose of extending credit on
the terms Kwik Stop provides on the attached contract. We authorize our bank and
suppliers to furnish you any information necessary to complete the evaluation of credit
history.
Authorized Signature ___________________________ Title ____________________
Date _________________
Revised 04/17/08
CREDIT TERMS AND PAYMENT POLICY

Terms are Net 15 Days from statement date.

Unpaid finance charges will be treated as any other charge to the account.
Any finance charge levied on the account is expected to be paid in full by the
date of the statement. The non-payment of a finance charge will place the
account on C.O.D.

All special requests, dated billings, and/or adjustments to an account must
have proper paper work completed for request and approval by the
Accounts Receivable Manager and CEO of Kwik Stop.

All new customers must complete the proper credit application and be
approved through our Accounts Receivable Manager.

All accounts that reach the 0 to 30 day status after the Net 10 days agreed
upon are surpassed, will receive a phone call from our Accounts Receivable
manager. If the balance expected is not paid by the next statement run the
account status will be turned to C.O.D. following one last phone call giving a
final date for payment.

Customers who have been switched to C.O.D. will be given ONE chance.
The first time a customer is put on C.O.D. status they will be allowed to
charge when the entire account is paid in full (including all finance charges).
The second time a customer is placed on C.O.D. status, they will not be able
to obtain credit again.
I have read and agree to follow these payment terms.
_______________________________
Authorized Customer Signature
_______________
Date
Revised 04/17/08
Welcome to Kwik Stop Convenience Stores!
We offer the most convenient, friendly stores around. We would be proud to serve
you for all your gas and diesel fuel purchases along with the great food programs we
have to offer. Consider us for your next employee or driver’s meeting. Our
breakfast, lunch or dinner ideas would please everyone and make your meeting
planning quick and easy. Visit us at any of our convenient locations!
Kwik Stop, Where the Customer Comes First!
Kwik Stop
2335 University Ave.
Dubuque, IA 52001
563-556-2059
Kwik Stop
2320 Hwy 61
Dubuque, IA 52003
563-582-4645
Kwik Stop
2255 Kerper Blvd
Dubuque, IA 52001
563-582-8803
Truck Stop With Diesel
Kwik Stop
4039 Pennsylvania Ave
Dubuque, IA 52002
563-589-0009
C-Store With Diesel
Kwik Stop
2390 Central Ave
Dubuque IA 52001
563-583-9800
Kwik Stop
14th & Central
Dubuque, IA 52001
563-556-2674
Kwik Stop
110 E Jefferson St
Delaware, IA 52036
563-922-2728
Truck Stop with Diesel
Kwik Stop
740 18th Ave SW
Dyersville, IA 52040
563-875-8490
Truck Stop with Diesel
KeyWest Conoco
2150 Twin Valley Drive
Dubuque, IA 52003
563-583-8011
Truck Stop with Diesel
Revised 04/17/08