Flex Term Program
Revenue Application
Date
-
Month
-
Day
Year
Date
STATE
*
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State Where Your Project is Located
Utility Information
UTILITY NAME
*
Address
*
Street Address
Street Address Line 2
City
State
Zip Code
Utility Contact
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Project Details
BRIEF PROJECT DESCRIPTION
*
Total Project Cost
*
Amount Borrowed (excluding financing cost)
*
ESTIMATED date for construction bids
*
/
Month
/
Day
Year
Date
Approximate date when financing is needed
*
/
Month
/
Day
Year
Date
Please submit current ordinance/tariff containing current & sewer rates along with effective rate
*
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of
Please submit the most recent 3 audits
*
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of
KEY PROJECT CONTACT INFORMATION
Please provide the following contact information regarding your project
PROJECT ENGINEER
Company
*
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Auditor / CPA
Company
*
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
BOND COUNSEL
Firm
*
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
FINANCIAL ADVISOR (IF APPLICABLE)
Firm
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Water & Sewer Customer Information
Number of Water Customers
*
Rows
Year
Residental
Other
Total
Most Recent
Previous
Previous
Previous
Previous
Number of Sewer Customers
*
Rows
Year
Residental
Other
Total
Most Recent
Previous
Previous
Previous
Previous Year
Five Largest Water Customers
*
Rows
Customer Name
Annual Sales
Usage (Gallons)
% of Total Usage
1
2
3
4
5
Five Largest Sewer Customers
*
Rows
Customer Name
Annual Sales
Usage (Gallons)
% of Total Usage
1
2
3
4
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