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TAX EXEMPTION & REPORTING ENROLLMENT FORM Instructions: 1. Complete part A and sign format the bottom. 2. Attach FEDERAL Certificate of Buyer and STATE forms (see detailsbelow). 3. For questions on signing up fortax exemption and reporting, please call 1-866-841-3542 or email GovTaxServicesC@WEXInc.com. 4. Email completed forms to TaxExemDtForms(@WEXlnc.com, fax to 1-207-5237104, ormail to Fleet Services, Tax Exempt Department, P.O. Box 639, Portland, ME 04104. 5. Retain the terms on page 2 for your records. A. • •• • Fleet Name: WEX Account Number (if known): Authorized Fleet Contact: Phone No.: Fleet Contact email: Fax No.: Federal Taxpayer ID Number: IMPORTANT: Eligibility may be limited based on applicable federal, state and local laws. Participating Entities must fill out these forms completely and accurately in order to avoid delays in their program enrollment, so please follow the instructions carefully. B. • •• FUEL TAX • Tax regulations require the Contractor to maintain current copies of the following applicable forms, based on the Participating Entity's eligibility: 1. Federal — A Certificate of Buyer of Taxable Fuel in the name of WEX BANK (Included with this form.) 2. State — Applicable state forms. (Obtain these from the appropriate state governing body.) • Once the Contractor receives all of the Participating Entity's properly completed documentation the Contractor will complete the tax exemption set up on their account within approximately three business days and start billing them net of the Applicable Taxes. The parties agree that a signed transmission shall be considered valid for purposes of this enrollment form and that the parties hereby waive any claim that a transmission does not satisfy the requirements of a signature or writing under applicable law. X Authorized Fleet Signature USER (INTERNAL USE ONLY): Date: The information contained in this message is intended only for the use ofthe individual or entity named above and may contain confidential information. If the recipient of this message is not the intended recipient, or the employee or agent responsible for delivering the message to the intended recipient, you are hereby notified that any dissemination, distribution, or copying of this communication is strictly prohibited. If you have received this communication in error, please notify us immediately at 1-800-492-0669 and return the original message to the attention of the sender at 97 Darling Avenue, South Portland, ME 04106. MASTER AGREEMENT No. 00819 — FLEET CARD SERVICES PAGE 48 OF 138