Municipal Information Form

General Information for Municipality

Legal Name of Lessee This field is required

Address This field is required

City This field is required

State This field is required

Zip This field is required

County This field is required

Federal Tax ID This field is required

Bond Rating (if applicable)

Primary Contact Name This field is required

Title This field is required

Office Phone Number This field is required Invalid Format

Cell Phone Number Invalid Format

Email Address This field is required Invalid Format

Second Contact Name This field is required

Title This field is required

Office Phone Number This field is required Invalid Format

Cell Phone Number Invalid Format

Email Address This field is required Invalid Format

Name of Insurance Carrier/Agent

Phone Number

Do you self-insure for property and/or liability insurance?

Yes No

Name of Attorney

Phone Number Invalid Format

Email Address Invalid Format

Population Served

Coverage Area (sq. miles)

Number of fleet vehicles

Transaction Information

Equipment Description This field is required

Equipment Cost This field is required

Delivery Date This field is required

Down Payment

# of Payments This field is required

Trade In /Other

Payment Frequency This field is required

Amount to Finance This field is required

Essential Use & Vendor Information

Replacement? This field is required

Yes No

If yes, explain why equipment is being replaced. If no, explain why the addition is needed.

New Equipment This field is required

Yes No

Vehicle Year (if applicable)

Miles (if used)

Vendor/Dealer

Salesperson's Name

Email Address Invalid Format

Phone Invalid Format

Other Information

If lessee's expenditures exceeded revenues during any of the last 3 years, explain why and describe the actions taken to connect shortfall.

Will the lessee issue more than $10,000,000 in new tax-exempt debt in this calendar year? This field is required

Yes No

Has the lessee defaulted or non-appropriated on a prior lease, bond, or legal obligation? This field is required

Yes No

Are there any judgements, liens, or bankruptcies on/against the municipality? This field is required

Yes No

Required Financial Information

Current year's completed audits, tax returns, or year-end financial statements This field is required

Previous year's completed audits, tax returns, or year-end financial statements This field is required

Two year's prior completed audits, tax returns, or year-end financial statements This field is required

If the fiscal year-end of the last audit is more than 6 months old, provide year-to-date Balance Sheet & Income Statement

Current Year's Budget or Other Support Documentation

Completed by

Name This field is required

Title

I certify everything stated in this form is correct to the best of my knowledge. Lessor is authorized to verify any information on this form with an appropriate third party as necessary to complete the credit review process. Lessor is authorized to contact insurance to obtain carrier information as part of the credit review process. My signature authorizes said agent to release the information to CLP. Upon submission of this form, we are committing to work with CLP and acknowledge failure to complete the lease in its entirety may result in a $500 documentation fee being charged.

Municipal Information Form

General Information for Municipality

Transaction Information

Essential Use & Vendor Information

Other Information

Required Financial Information

Completed by

Signature

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