Toll Free: (800) 991-0099     Fax: (916) 988-3931
Folsom, CA
info@leasource.com

Online Municipal Lease Application

 

 

Please complete as much of this form as possible before submitting the application. Items in bold are required. Also, please fax a copy of your latest completed balance sheet and income statement to 916-988-3931.

LESSEE INFORMATION
Legal Name of Lessee:
Phone Number:
Fax Number:
Contact Person:
Title:
Email Address:
Company Address:

City:
State/Province:
Zip/Postal Code:
Date municipal entity was established:
Federal Tax ID:
EQUIPMENT INFORMATION
Total Cost of Equipment: $ Term (Years):
Down Payment: $ Anticipated Delivery Date:
Trade-in: $ Payment Mode:


Amount to Finance: $
Payments will be made in:

Is the equipment replacing existing "like" equipment?
If yes, how many years has the current equipment been in use?
What is the reason for purchasing new equipment?

Please describe the equipment being financed:

Vendor web site address:

Equipment to be financed is:

Please describe in detail why the equipment is essential and the use it will provide:

FUNDING INFORMATION
Please specify which fund the rental payments will be made from:

The appropriations for this project have been:

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

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

Person signing documents is:
Title:
Person authorizing signatory to execute documents is:
Title of person authorizing signatory:


Please fax a copy of your latest completed balance sheet and income statement to Leasource at 916-988-3931.