Online Municipal Lease Application

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Please complete as much information as possible then click the Submit button at the bottom of the Online Municipal Lease Application form.

Municipal Lessee Information

Legal Name of Lessee:

Contact Person:

Title:

Phone:

Fax:

Email Address:

Street Address:

City:

State/Province:

Zip/Postal Code:

Date Municipality was Established:

Federal Tax ID:

Equipment Description:

Cost of Equipment: $

Down Payment: $

Trade-In: $

Amount to Finance: $

Term (Years):

Delivery Date:

Payment Mode:

Payments made in:

Replacing "like" equipment?

If Yes, how long has the equipment been in use?

Reason for purchasing new equipment?

Vendor Website:

Equipment is:

Describe why the equipment is essential use:

Which Fund will rental payments be made from:

Appropriations for this project have been:

Have you ever been in Default or Non-Appropriated on a Municipal Lease?

	Yes
	No

Will you borrow more or less than $10,000,000 in total new borrowing during this calendar year?

	More
	Less

Person Signing documents:

Title:

Person Authorizing Signatory to execute documents:

Title of Person Authorizing Signatory

Other:

Please enter the word that you see below.

Fax the your recent Balance Sheet & Income Statement
to 612-435-4811