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APPLICATION FOR ACCG EQUIPMENT FINANCING PROGRAM1. Application Date: 2. Bid Date: (Must be at least 10 business days from the application date.)3. Authorization Date: (Date County will adopt authorizing resolution. Must be no more than 14 days after the bid date.)4. Closing Date: (Must be within 30 days of the bid date.)5. Name of County: 6. Tax ID: 7. Primary Contact: NamePhoneEmail8. Mailing Address:9. Physical Address:10. Document Signer:NameTitle11. Amount of Lease: $_________________________12. Desired Term (Years):(Term may not exceed the life expectancy of the equipment financed.)13. Equipment Description:(Attach an Exhibit if necessary.)14. Use of Equipment:15. Desired Payment Frequency: ? Monthly ? Quarterly ? Semiannually ? Annually16. Planned Source of Repayment:17. County Attorney Information:Name:Phone:Email:Street Address:City/State/Zip18. Bank Qualification: The Lease will ? will not ? be designated as “bank qualified” under Section 265(b)(3) of the Code. The Lease should be designated as bank qualified if the Lease together with all other debt issued or incurred by the County and its subordinate entities (e.g., authorities created or controlled by the County) during the calendar year will be less than $10m.Please email this completed form to Brent Williams – bwilliams@ and to Kelly Pridgen – kpridgen@ ................
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