Call: 1-888-LDS-3100

Credit Application for Municipalities

Lesee Information

Legal Name of Lessee *

Address

City

County

State

Zip

Contact Person

Title

Alternative Contact Person

Title

Email *

Telephone *

Fax

Year municipal entity was established:

Does the Lessee self-insure for property & liability?

Financial Information

Total Cost of Equipment

Down Payment

Source of Down Payment

Delivery Date

Trade In

Other

Payment Amount, $

Payment Due
(e.g., Advance or Arrears)

Amount to Finance

Payments
(e.g., Monthly, Quarterly, Semi-Annual, Annual)

Equipment Description

Equipment Description-including make & model

New Equipment

If used, please list age of equipment or manufactured date

Refurbished

Year

Replacement

Age of Current Equipment

Year Purchased

If not a replacement, why is the equipment needed?

Buyout Included

Amount of buyout being financed

Soft Costs Financed

Amount of soft costs included (shipping, software & sales tax)

If the equipment is a building, do you own the land?

Describe the essential use of the equipment purchased

Physical location of equipment after delivery

Lessee ever defaulted or non-appropriated on a lease or bond?

Will the Lessee issue more than $10,000,000 in tax-exempt debt in this calendar year?

What fund will the remaining lease payments be made from?

Will the down payment be made at or before delivery?

Transactions between $100,000 to $500,000 or above $50,000 & greater than 5 years

Please attach 1 year of the most recent Financial Statements (Audits Preferred).

Please Complete for Transactions up to $100,000

Total Revenue

Combined Total Funds of Lessee

Current Year (Actual YTD)

Prior Year (Actual not Budget)

Total Expenditures

Combined Total Funds of Lessee

Current Year (Actual YTD)

Prior Year (Actual not Budget)

Net Income

Combined Total Funds of Lessee

Current Year (Actual YTD)

Prior Year (Actual not Budget)

Fund Equity (per Balance Sheet)

Combined Total Funds of Lessee

Current Year (Actual YTD)

Prior Year (Actual not Budget)

By clicking “Send”, I agree to the above statements.

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Credit Application for Municipalities

Transactions between $100,000 to $500,000 or above $50,000 & greater than 5 years

Please attach 1 year of the most recent Financial Statements (Audits Preferred).

Please Complete for Transactions up to $100,000

Net Income

Fund Equity (per Balance Sheet)