PROPERTY OF EVERY DESCRIPTION  (Fill in ALL Blanks. If NONE, State NONE.)

Building #1: $   Tenant Improvements: $   Hoists: # $   Canopy (Height in feet) $   Awnings:# $

Building #2: $   Office Equipment:       $    Signs:$    Stock: $

Building #3:$  Underground Tanks:  # $  Aboveground Tanks:  # $  

Max Gas Value:$  Max Propane Value:$

Gas Pumps:  # $  Propane Tanks:  # $   Propane: $   Inside Car Wash Equipment: $

Outside Car Wash Equipment  Vacuums:  # $  Vending Machines:  # $   Equipment (Fences, Lights, etc.) $

Other operations not already included:       $

Sales Per Year  (If NONE, State NONE.)

Gas Sales: $   Drive Through Car Wash Sales: $   Coin Op Car Wash Sales: $   Convenience Sales: $

Propane Sales: $   Repair Shop Sales: $   Other Sales Not Already Included: $

Desribe Other Sales (e.g. Lube Shop, Restaurant):    If Restaurant, Advise of Liquor Receipts $

Underwriting Information  (Please Check the Right Description)

Are you within 500ft of a fire hydrant? Yes No   Do you have an alarm system? Yes No   Maximum cash on site at any time? $