Customer finance proposal form

Customer Finance Proposal
1. Supplier Details
Supplier’s Name
Registered No.
Contact Telephone No.
Supplier’s Address
Contact Name
Email Address
Postcode
2. Customer Details
Registered Company Name
Contact Name
Contact Telephone No.
Trading Address
Nature of Business
Time in Business
Trading Name
Email Address
Postcode
Registered No.
Type of Business*
Technical Question Contact: Please provide contact details in the event that we have technical questions about your project
Contact Name
Telephone
* If Sole Trader or Partnership, please complete Appendix A
3. Financial Details & Terms
Equipment Price ex VAT
Installation Cost ex VAT
Amount to be financed
£
£
£
4. Project Details
Type of Technology and
Manufacturer
Brief Description of project to
be financed
Anticipated annual energy
savings
Type of Agreement
Financing Term
Payment frequency
(All payments will be taken by direct debit)
£
Any other additional savings
arising from the project (e.g.
avoided waste disposal costs,
reduced maintenance, water
savings)
Anticipated income
£
from any applicable
government incentives,
e.g. Fit / and or RHI
Project Start
Date or
Installation Date
Please ensure latest financials are included with every proposal.
Please return this form to:
Energy Efficiency Financing, Siemens Financial Services Limited, Sefton Park, Bells Hill,
Stoke Poges, Buckinghamshire SL2 4JS • E-mail: [email protected]
This information will be used to conduct a credit check. Upon credit acceptance, we will be back in touch to request more information regarding your project.
Energy saving
assessment by
Financial Services
provided by
Appendix A - Personal Details
Required for Sole Traders and Partnerships
Personal Details
IMPORTANT INFORMATION - USE OF PERSONAL DATA
We may share any personal information supplied by the Customer on this form (either directly or via the
supplier) with Siemens Financial Services, Carbon Trust Group companies, the equipment supplier, credit
references agencies and fraud prevention agencies.
Please confirm (the Customer’s) consent to use of personal data by ticking this box
Customer signature:
Directors Name
Date of Birth
Home Address
Post Code
How long at address?
Previous Address
if < 3 years
Post code
Directors Name
Date of Birth
Home Address
Post Code
How long at address?
Previous Address
if < 3 years
Post code
Directors Name
Date of Birth
Home Address
Post Code
How long at address?
Previous Address
if < 3 years
Post code
Please return this form and supporting information to:
Energy Efficiency Financing, Siemens Financial Services Limited, Sefton Park, Bells Hill,
Stoke Poges, Buckinghamshire SL2 4JS • E-mail: [email protected]
This information will be used to conduct a credit check. Upon credit acceptance, we will be back in touch to request more information regarding your project.
Energy saving
assessment by
Financial Services
provided by
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