FireFly-One Application

"*" indicates required fields

Business Information

Amount Needed To Fund Project*

Include soft costs for Engineering, labor, Installation, Etc.

Legal Business Name*

Copy of current business license required

Business Telephone*

Name of CPA or Auditor / Phone Number*

Name or company name of financial advisor

Business Description*

A brief overview of your company services or products provided.

Name of Primary Bank*

Please attach a voided check with the document uploads

Primary Business Address / Corporate Office*

Street Address City State ZIP Code

Years in Business*

Annual Revenue*

Business Structure*

Company Website*

Audited Financials?

Federal Tax ID #*

Trade Reference / Contact Information*

Preferred Length of Lease

Equipment Details

Please Provide Details On The Specific FireFly-One Lights You Are Ordering * Attach invoices*

If you have a long list of lights for multiple properties please email to proposals@equipmentleases.com

Are there tax credits available with the purchase of this equipment?*

Where Will Equipment Be Located*

Required Attachments*

Drop files here or

Max. file size: 32 MB.

Scan and upload the following 1) 3-months bank statements or Current Financial Statement 2) Interim Financials 3) Copy of Drivers License Front/Back 4) Invoices for all equipment purchased from FireFly-One 5) Copy of current business license 6) voided company check

Signatures

Signature*

Name/Title*

Date*

Owner Information

Name*

First Last

SSN #*

% Ownership (For 15% + Owners )*

Cell Phone #*

Email Address*

Enter Email Confirm Email

Title

Home Address*

Street Address City State ZIP Code

Owner #2

Add Owner #2 Information

Owner 2 Information

Name*

First Last

Social Security Number*

% Ownership (For 15% + Owners )*

Cell Phone #*

Email Address*

Enter Email Confirm Email

Title

Address*

Street Address City State ZIP Code

Patriot Act Compliance Information

Applicants Drivers License Number*

Issuing State

Expiration Date*

Signature of Applicant*

Date*

Signature of Co-Applicant

Date

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