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