MuniApp

Municipal/Government Credit Application

* Required Field

*Legal Name of Obligor

*Phone Number

*Federal Tax ID #

*Physical Street Address

*City

*State

*Zip Code

Different Billing Address?

Billing Address

City

State

Zip Code

Company Email

Company Structure

*Date Established

Does the obligor self-insure for property & liability insurance?

Yes No

*Contact Person

*Title

*Contact Email

Alternate Contact Person

*Title

*Alternate Email

Equipment/Project Information

Equipment Description

Is the equipment new or used?

New Used

If equipment is used or refurbished, please enter the year or date manufactured.

Is this replacement equipment?

Yes No

If yes, what is the age of current equipment and year it was purchased?

If no, why is this equipment needed?

*Total Cost of Equipment/Project

$5,000 minimum

Term (years)

How long would you like to finance?

Describe the essential use of the equipment:

Down Payment

Do you plan on making a down payment?

Source of Down Payment

Proof of down payment typically required.

Has the obligor paid, or does obligor intend to pay, a vendor for any portion of the equipment being financed with the intent

Yes No

What fund will the remaining obligor payments be made from?

Will any federal monies be applied to the contract payments?

Vendor

What vendor(s) are you buying from?

Has the obligor ever defaulted or non-appropriated on a lease, bond, or legal obligation?

Yes No

Financial Information Required

Please have the following information ready to submit upon request.

- Two (2) most recent tax returns WITH schedule of Debt Service Commitments (or audit), and
- If the fiscal year end of the return (audit) is more than three (3) months ago, also provide current year-to-date
Balance Sheet with Debt Service Commitments and Income Statement
- For any fiscal year without a return (audit) provide comprehensive financial statements to include a Balance Sheet
with Debt Service Commitments and an Income Statement
- A copy of the Articles of Incorporation

Declaration

Additional financial information may be requested if deemed necessary during credit review.
By signing this application Obligor representative agrees to the following statement: “Everything stated in this application is correct to the best of my knowledge. I
understand Obligee will retain this application whether or not it is approved. Obligor is authorized to verify any information on this application with an appropriate
third party as necessary to complete the credit review process.”
Please note that, depending on circumstances, we reserve the right to charge a reasonable fee to Obligor/broker, if this transaction is not funded. This fee is for
expenses incurred and services performed related to the processing of the transaction. This fee will NOT be charged if the transaction is funded by Obligee.

Terms & Conditions

I have read and agree to the Terms & Conditions above.