Empire Petroleum Services Online Application
The applicant (Applicant) certifies to Patriot Capital ("Patriot") that it is applying for credit for business purposes, and not for personal, family or home use. By submitting this application the Applicant agrees that Patriot or its agents have the right to confirm the accuracy of the above-referenced credit information and that Patriot or its agents have the right to accept or reject this credit application. By submitting, the applicant individual as principal of and/or guarantor for the Applicant, authorizes Patriot, its designee, assigns or potential assigns, to review his/her personal credit profile provided by a national credit bureau in considering this Application and for the purpose of update, renewal, or extension of credit to the Applicant or the collection of any resultant accounts. The Applicant authorizes all deposit, borrowing, financial and trade information to be provided to Patriot by telephone or fax. A photocopy or fax of this authorization shall be valid as the original. Financing subject to approval.'