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Price Quotation Format in Excel

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					                                               CREDIT APPLICATION

CISCO SYSTEMS CAPITAL CORPORATION                                                   Lease Manager:
170 West Tasman Drive                                                               Lease Support:
San Jose, CA 95134-1706                                                             Tel:                            FAX:

CUSTOMER INFORMATION
Legal Company Name                                                               Trade Name/dba                                 Federal Tax ID#


Tel No.                                            Fax No.                                                         Contact Person/Title

E mail address
Billing Address                                                           City                             State                Zip

Type of Business/Product                                  No. Of Years in        Annual Sales
•Proprietorship •Partnership •Corporation                 Business
•Other___________
EQUIPMENT TO BE LEASED (Attach price quotation in excel format specifying equipment configuration).
Equipment Source:                                 Telephone No.              Contact
• Cisco Systems, Inc.    • VAR/Distributor
TRADE REFERENCES
Name of Supplier          Acct. No.               Telephone No.              Contact

Name of Supplier                      Acct. No.                             Telephone No.                          Contact

Landlord-Equipment Location                                    Telephone No.                                       Contact

FINANCIAL INFORMATION AND BANK REFERENCES
** If deal size > $250,000 Please Include Annual Financial Statements (last 2 years) and Current Interim
Financial Statements
Name of Bank/Branch                    Checking Acct. #                              Telephone No.
City/State                             ____________________________________
                                       Loan Acct. #

Name of Bank/Branch                                Checking Acct. #                                                Telephone No.
City/State                                         ____________________________________
                                                   Loan Acct. #

AUTHORIZATION
In connection with the review of this application, Cisco Systems Capital Corporation intends to obtain and verify information from the
individuals or organizations listed as bank and trade references. I hereby certify that the information contained in this application is,
to the best of my knowledge, true and correct. We/I hereby authorize you to verify with third parties or any credit bureau or other
investigative agency employed by Cisco Systems Capital Corporation, any of the information concerning the information provided in
this application, including, if applicable, the personal information regarding the personal credit history of our officers, partners,
shareholders or owners .

If you are state sales tax exempt, you must provide Cisco Systems, Inc. with a signed sales tax exemption certificate.


Name: _________________________________

Signature ______________________________

Title: __________________________________

Terms Requested: (Check ONE)                           36 months            48 months            60 months

				
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