APPLICATION TERMS AND CONDITIONS

Complete application package will include completion of all applicable fields, engineer stamped plans, certificate of insurance and confirmation of payment. Incomplete applications, including missing information in required fields, may result in processing delays. Applications submitted without the required fees will not be processed.

Please note, if the submitted application and plans require review by any independent environmental (HAZMAT) or other outside consultants, this review will be at applicant’s sole cost and in addition to the aforementioned fees.

***Canadian residents/businesses: this fee is a taxable supply, please include applicable GST***

STANDARD APPLICATION PROCESS IS 60-90 DAYS DEPENDING ON THE COMPLEXITY OF THE APPLICATION. REQUEST FOR RUSH SERVICE IS AVAILABLE WITH AN ADDITIONAL FEE. Once a COMPLETED application package and required fees are received, including the rush fee of $1,500 USD ($1,903 CAD), a draft agreement will be made available for review within twenty-one (21) business days, assuming submission of completed application. Please be sure to mark the RUSH box below for projects requiring expedited review.

If the application is approved, the applicant agrees to reimburse property owner for any cost incurred resulting from the installation, maintenance, and/or supervision and further agrees to assume all liability for accidents or injuries which arise as a result of this installation. In addition, annual fees will be assessed pursuant to a written lease agreement.

Once an executable agreement is submitted to you, this agreement must be fully negotiated and executed within thirty (30) days. If not executed, the application and materials will be archived and resubmission (including fees) will be required.

PLEASE INITIAL HERE INDICATING YOUR UNDERSTANDING OF THIS POLICY :

Upon submission of your application you will be provided with an opportunity number, please ensure to reference the opportunity number on the method of payment to ensure proper allocation. Send payment for the non-refundable fee of $5,000 USD ($6,342 CAD) to:

OmniTRAX Holdings Combined, Inc.
PO Box 209979
Dallas, TX 75320-9979

	RUSH
Check the box if this is a RUSH application. Add $1,500 USD ($1,903 CAD) in addition to the application fee listed above.

Provide Check Number :

CERTIFICATE OF INSURANCE :

Upon submission of your application, you are required to submit a Certificate of Insurance. In addition, you will be required to obtain a CG 24 17 10 endorsement. Please ensure to name the Railroad as the Certificate Holder and that all required coverages are evidenced. Please review the templates for Certificate of Insurance and CG 24 17 10 Endorsement, linked here.

Railroad (Certificate Holder)

Please attach the Certificate of Insurance, including all required coverages and naming the selected Certificate Holder :

RR Acronym :

RR Record ID :

Section 1 - Customer Account Information (Complete this section on behalf of the Agreement Entity and include information as it would be listed in the Agreement) :

Account Information

Is this application for a new customer account or an existing customer account?

Mailing Account Information :

Account Name :

Type of Account (please select one):

Federal Tax Identification number (U.S. Leases):

Mailing Street :

Mailing City :

Mailing State :

Mailing Zip Code :

Account Contact First Name :

Account Contact Last Name :

Account Contact Title :

Account Contact Email :

Account Contact Phone :

If applicable, State/Province of incorporation or organization :

Email Address Where Notices Can be Sent to :

Overnight Delivery Service Address (if different) :

Application Status

Source of Opportunity

Billing Account Information(Complete this section on behalf of the entity responsible for annual Agreement payments) :

Same as Mailing Account :

YesNo

New Billing Account Information :

Billing Account Name :

Billing Contact First Name :

Billing Contact Last Name :

Billing Phone Number :

Billing Street :

Billing City :

Billing State :

Billing Zip Code :

ABV. APP TYPE

Billing Email :

Billing Account Information Same as Mailing Account :

Billing Account Name :

Billing Street :

Billing City :

Billing State :

Billing Zip Code :

Billing Contact First Name :

Billing Contact Last Name :

Billing Phone Number :

Billing Email :

Section 2 - Application Location Details

IDENTIFY WHAT TYPE OF LAND LEASE APPLICANT IS REQUESTING :

Application Type (General Land Lease - Default API Value) :

Railroad :

Subdivision :

Nearest Railroad Milepost :

Nearest DOT Number :

Property Address/Street :

Property City :

Property County :

Property State or Province :

Property Country :

Opportunity Currency

Section :

Township :

Range :

Geographical Coordinates Required (Decimal Degrees DD) :

Property Coordinate (Latitude) :

Property Coordinate (Longitude) :

Located on the (N/S/E/W) side of (landmark, intersection)

Section 3 - Engineering Plans :

Provide location (i.e. city, street, railroad milepost) and engineer stamped plans of the proposed leased premises with dimensions, coordinates and directions. Also depict any planned improvements on the leased premises with dimensions from nearest track (may incur additional costs or agreements for above ground occupancy).

If applicable, please attach the detailed Engineering plans for your project here :

Section 4 - APPLICATION DETAILS :

Product Category :

Product Sub-Category :

Do you plan to sublease to another party ?

Please name the customer/entity subleasing :

Estimated area of land to be leased (Sq ft) :

Detailed description of intended use of leased premises :

Will there be hazardous materials or petroleum products/waste handled on the leased premises?

Will hazardous or petroleum waste be generated?

If yes, please describe :

List all hazardous materials or petroleum products you will be handling on the leased premises, including STCC numbers:

Will improvements be constructed on the leased premises ?

If Yes, Describe :

Plans Required :

Will storage tanks be placed on the leased premises?

If Yes, how many Tanks will be stored ?

Above Ground

YesNo

Below Ground

YesNo

Size (Gallons)

STCC

Commodities stored :

For Signboard Requests :

For Residential Requests:

Proposed access to spaces :

For Cell Tower Requests :

Area of pad (square feet) :

Distance from centerline of nearest rail (feet) :

Distance from power source (feet) :

Tower height (feet) :

Number of anticipated tenants :

Proposed power source :

For Farm Requests :

Types of Commodities :

Tillable Area (Notate Square feet/acres) :

For Timber Requests :

Describe the proposed access :

List the types of trees to be harvested :

Proposed sustainable forest plan :

For a Building Request :

Please select the type of Building Request :

Area of building or space within that is being requested (square feet) :

Proposed access to building :

For Beautification Requests:

Proposed Beautification to Railroad- Owned property will include:

For Parking Requests :

Number of spaces required :

Proposed access to spaces :

Will spaces be :

Additional Land Lease Information

Are modifications being made to an existing agreement ?

What is the type of Modification ?

Lease Number :

Lease Date :

By submitting this application for credit, you authorize OmniTRAX, Inc. or it's affiliates, to make any inquiries necessary to determine credit worthiness. You release your banking instruction release details that would assist to determine credit worthiness.

I hereby certify that the information contained herein is complete and accurate. This information has been furnished with the understanding that it is to be used to determine the amount and conditions of the credit to be extended. Furthermore, I hereby authorize the financial institutions listed in this credit application to release necessary information to the company for which credit is being applied for in order to verify the information contained herein. Our terms of sale and service are NET 30 DAYS from the date listed on the invoice. Invoices that are beyond granted terms will be assessed a late fee of 18% APR (1.5% monthly) additional Terms and Conditions apply. A $20.00 charge will apply for any NSF/Non-Sufficient Checks.

Applicant Contact Information

LIST CHECK NUMBERS

Applicant Contact First Name :

Applicant Contact Last Name :

Applicant Contact Email :

Applicant Contact Phone :

Application Date :

Applicant Signature :

Portal

Skip this step for now :

Yes

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