Municipal Finance Credit Application

Municipality Business Information :
Legal Name of Municipality/ Obligor: Federal ID:
Address:
City: State: Zip:
County:
Phone: ...Fax: Email:
Gross Annual Revenue: ....... State Organization ID :
Contact Name / Title: Contact Title:
Contact Phone / email: Contact Phone: Contact email:
Alternate Contact / Title: Alt Contact Title:
Alt Contact Phone / email: Alt Contact Phone: Alt 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:
Date Municipality Entity Was Established Does the obligor self-insure for property & liability insurance?
Within the current calendar year, we
Equipment Information (Attach separate sheet if necessary)
Equipment Description:
Manufacturer: Model: Year:
Quantity: Equipment Cost:$ Total Cost:$
Equipment Location:
Location City / Zip: Location City: .State: Zip:
Equipment: Equipment is Additional
Soft Costs Included: Amount of soft costs included (shipping, software, and sales tax): $
Buyout Included: $

Describe the essential use of the equipment:

Is the project a building? If yes, who owns the land?
What is the physical address of the new building/project?
Lease Terms Desired:
Length of Lease Term:
Payment Mode:
First Payment Due:
Other Requests/ Requirements:
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 Terrace Finance (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 Terrace Finance or that purpose. Applicant understands that Terrace Finance will retain this application whether or not credit is granted.

Phone: 888-464-6256

email: credit@terracefinance.com