Municipal Finance Credit Application

Municipality Business Information :
Municipality Name:
Address:
City: State: Zip:
Phone: ...Fax: Email:
Gross Annual Revenue: ....... State Organization ID : Federal ID:
Contact Name / Title: Contact Title:
Contact Phone / email: Contact Phone: Contact email:
Type of Municipality:
Population: Households: Department/Agency:
Fiscal Officer / Title: Fiscal Officer Name: ....Title:
Fiscal Officer Phone / Fax: Fiscal Officer Phone: Fiscal Officer Fax:
Please check the appropriate box:
Within the current calendar year, we
Lease Terms Desired:
Length of Lease Term:
Payment Mode:
First Payment Due:
Equipment Information (Attach separate sheet if necessary)
Manufacturer: Model: Year:
Quantity: Equipment Cost: Total Cost:
Equipment Location:
Location City / Zip: Location City: .State: Zip:
Equipment: Equipment is Additional
Vendor Information (Attach separate sheet if necessary)
Vendor Company: Vendor Contact email:
Vendor Contact Name: Vendor Contact Phone:
Vendor City, ST, Zip: Vendor City: State: Zip:

By submitting this application, I (we) is (are) providing an Electronic Signature. An electronic signature, or e-signature, is any electronic means that indicates either that a person adopts the contents of an electronic message, or more broadly that the person who claims to have written a message is the one who wrote it (and that the message received is the one that was sent by this person). I (we) each individually as principals and/or guarantors of the Obligor, and on behalf of the Obligor (individually and collectively Applicant), hereby affirms that the foregoing information contained in this Credit Application is presented for the purpose of obtaining or maintaining credit as of the date indicated and is true, complete and correct. Applicant understands Capital Lease Funding, Inc. dba Capital Leasing Solutions (Lender or Lessor) is relying on this statement of our financial condition in extending or continuing to extend credit to Applicant. Capital Leasing Solutions, its affiliates, successors, designees or assigns is/are authorized to make any investigation of Applicants credit either directly or through any agency employed by Capital Leasing Solutions for that purpose. Applicant understands that Capital Leasing Solutions will retain this application whether or not credit is granted.

 

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Phone: 888-464-6256 - Fax: 888-464-1947

email: credit@capital-leasing.com