Learn more about this exciting offer at www.tandemfinance.com/emvexpress

GET AHEAD IN THE EMV®

EXPRESS LANE

Purchase new Wayne

Ovation® and Helix®

fuel dispensers with

rates starting as low

as 3.9% for 60 months

Adams Tank & Lift has partnered with Tandem

Finance to make it easier than ever to get your

EMV-ready Wayne equipment ordered today.

Contact your regional representative todayNorthEast Florida Scott Johnson (407) 595-4417North/Central Florida Armando Lopez (352) 812-2287West/Central Florida Steve Storch (813) 917-3295East/Central Florida Angel Rivera (786) 778-2675 SouthWest Florida Sean Davis (727) 266-7109SouthEast Florida Manuel Rodriguez (786) 501-9438

Promotional rate is subject to credit approval and only apply to

eligible Wayne Fueling Systems products. This offer may not

be combined with any other Dover Fueling Solutions incentive

program. Installation must be completed by a Wayne ASO

and included on finance agreement. Other terms and

conditions may apply. Promotion expires December 31, 2020.

For more information, contact your regional sales representative

APPLY NOW

Corporation LLC Partnership Proprietorship

State Zip

State Zip

% of Ownership Date of Birth

State Zip

% of Ownership Date of Birth

State Zip

Company Information

Legal Business Name DBA Company Start Date

Business Phone Business Type

Business Address (No P.O. Box)

Officer Information

Primary Guarantor Title

City

Billing Address City

Home Address City

Cell Phone E-mail Address Social Security Number

Cell Phone E-mail Address Social Security Number

Secondary Guarantor Title

Secondary Guarantor Signature Date

Authorized Petroleum Brands Represented # of Stations Operated

Vendor Name Sales Rep

Petroleum Supply

Federal Tax ID

Primary Guarantor Signature Date

Purchase Description (Equipment type, quantity, etc.) Amount Term

Home Address City

Transaction Information

Petroleum Supplier Contact Name/Phone

TANDEM FINANCE understands that the applicant is considering asking TANDEM FINANCE to remit funds for the equipment described above from the Supplier to

enter into a finance agreement. I/We hereby request and authorize you, Tandem Finance to whom this application is made, or your agents or assigns, to investigate

my/our credit worthiness and will provide financial statements, tax returns, etc., as you deem necessary. By the execution of this application, I/we warrant that

the information submitted herein is true and correct and hereby authorize references contained herein to release any requested information. If any of the

applicants (i.e. guarantors) have not signed this application, I/we hereby warrant that I/we have their written authorization for you to investigate their credit. I/we

warrant it is understood that TANDEM FINANCE reserves the right to reverse any credit decision if the information contained herein is found to be incorrect, and I/

we will indemnify TANDEM FINANCE for any and all costs incurred with this application for credit including any cost incurred in the placement or reservation of the

intended leased equipment if any of the information contained herein turns out to be incorrect, and I/we hereby request any above named entity to consider

this to be our written request to release all information requested by TANDEM FINANCE to its affiliates. We also hereby acknowledge receipt of a copy of this

application. If your application for business credit is denied, you have the right to a written statement of the specific reasons for the denial.

Credit ApplicationSend completed application by fax to 855-631-0107 or email to apply@tandemfinance.com

Landlord/Property Owner Property Owner Contact Information