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ADDENDUM TO THE FUEL CARD SERVICES AGREEMENT BETWEEN WEX BANK AND THE STATE OF (the "STATE") INFORMATIONCREDIT Participating Entity agrees that in the event the account is not paid as agreed, WEX Bank may report the undersigned's liability far and the status of the account to credit bureaus and others who may lawfully receive such information. Participating Entity Phone If Fax# Headquarters Name and Physical Address (Do not include PO Box) Applicant's Taxpayer ID # (TIN, FEIN or SSN In Business Since (yyyy) Year of Incorporation Number of Veh Avg Monthly Fuel Expenditur Avg Monthly Service Expenditur $ $ ACCOUNT•• • Write Participating Entity name as it should appear on cards. Limit of 20 characters & spaces. Unless specified, no Purchasing Entity name will appear on cards. ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ El El ElEl El ❑ ❑ Billing Contact ing Address City State Zip+4 Designate the Fleet Contact authorized to receive all charge cards, reports, and other such information WEX provides from time to time and to take actions with respect to your account and account access. This is also the person designated by the Purchasing Entity to provide all fleet vehicles, driver and other information WEX may request. Authorized Fleet Contact Name Title Phone # Fax # Mailing Address (if different from billing address) City State Zip+4 Email address (required to take advantage of product type card controls) Card Controls: To help WEX estimate the Purchasing Entity's credit needs, indicate the types of cards they anticipate using. If the Purchasing Entity provides a valid email address above, they can select from these product type options: ❑ All Products ❑ Fuel & Service ❑ Fuel & Fluids with Roadside Assistance ❑ Fuel with Roadside Assistance ❑ Mix of card types ❑ Check here if business is exempt from motor fuels tax MASTER AGREEMENT No. 00819 - FLEET CARD SERVICES PAGE 40 OF 138