Credit Application

Volunteer Fire Department Credit Application
Lessee Legal Name *

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Year Incorporated
Station Phone Number *

- Area Code Phone Number
Number of Full Time Department Members
Number of Part Time Department Members
Contact Name *

First Name Last Name
Contact Phone Number *

- Area Code Phone Number
Demographics
Current Service Area:
Square Miles:
Population Serviced:
Number of Calls Per Year
Joint Service Area Contracts? Yes or No. If Yes, please explain.
Proposed Transaction Information
Total Cost *
Trade-In (if any)
Down Payment (if any)
Total Amount to Finance: *
From What Fund Will Down Payment Be Made (if any)?
From What Fund Will Lease Payments Be Made?
Will Down Payment Be Made At or Before Delivery?
Anticipated Delivery Date

- Month - Day Year
Date
Truck Description

If you are financing a building, please skip to "Building Project" to continue.
Make
Chassis
Body
Manufacturer
Year
Mileage
Supplier
New/Used/Refurbished?
Addition to Fleet or Replacement?
If Addition to Fleet, Why Needed? If Replacement Truck, How Old Is Previous Truck?
Building Project

Please submit a detailed description of the proposed building project via email to cbakos@univest.net or via fax to 866-463-1146, Attention: Chris Bakos.
Alternatively, you can upload your documentation here:
What is the essential use of the proposed building? Do you own the land?
Financial Information
SOURCE OF INCOME/REVENUES: Please explain the source of Income/Revenue for the department and how much is generated from each source. For Example: Contracts, fund raising events (frequency, targets and past experience), donations, endowments, state aid, etc.
OTHER LOANS OUTSTANDING: Please include the purpose, remaining term, current balance and payment amount of any other outstanding loans.
Are any of the assets of the Lessee invested either directly or through an investment pool in derivatives, inverse floaters, reverse repurchase agreements or any other investment that can be characterized as a "High Risk" investment?
Additional Required Financial Information

The following items MUST be submitted for proper credit review. You can submit via email to bakosc@univest.net or via fax to 866-463-1146, Attention: Chris Bakos.
1. Three years of your most recent audited financial statements or tax-returns. If neither are available, please contact us to request an Income Statement and Balance Sheet.
2. "Interim Statement" if the most recent information is more than 6 months old.
3. A copy of the most recent fiscal year's budget
4. Bank Account Details: Balances, Name of Bank, Contact Person, Phone Number and Account Numbers
5. Three Trade References: Name of Company, Contact Person, Phone Number and Type of Business.
Alternatively, you can upload your documentation here:
Agreement

By submitting this form, applicant hereby authorizes the Lessor to investigate the references herein listed or statements or other data obtained from applicant or any other person pertaining to this transaction. This application is made under and shall be governed by the laws of the State of Pennsylvania. All loan applications are subject to approval. Interest rates vary based on credit score and other credit criteria. Univest Capital, Inc. is a subsidiary of Univest Bank and Trust Co. Equal Opportunity Lender.
Please Call for an Application - 1.866.604.8160
Should be Empty:

Volunteer Fire Department Credit Application

Demographics

Proposed Transaction Information

Truck Description

Building Project

Financial Information

Additional Required Financial Information