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Client Profile Name of MCM Contact: Entity's *Name: Billing Address: City: State, Zip: , Phone: Fax: Contact Person: Title: Type of Entity: Please Choose One Agency Authority Borough Charter School - not-for-profit City College - not-for-profit College - publicly owned County District Hospital - not-for-profit Hospital - publicly owned Housing authority Joint power authority Manufacturer Mental health care provider - not-for-profit Mental health care provider - publicly owned Metropolitan district Municipal corporation Municipal corporation or authority - not-for-profit Municipal utility or district Municipality Parish Public building corporation or authority - not-for-profit Recreation district or department Sanitation board, district or department School building corporation or authority - not-for-profit School district School - primary and or secondary - not-for-profit Sewer district or department Special district State Town Township U. S. Territory University - not-for-profit University - publicly owned Utility - publicly owned Water and sewer board or district Water board or district Date Incorporated: Tax ID#:(optional) *E-mail: Brokers & Vendors MCM Broker ID# Check here if the borrower does not wish to be represented by a broker Property to be Financed Seller's Name: Address: City, State, Zip Phone: Fax: Contact Person: E-Mail Address: Property Description: New Used Equipment Cost: 1. $ 2. $ 3. $ 4. $ 5. $ 6. $ Freight, Installation, other costs $ Total Cost $ Term Requested in months: Does the entity plan to issue more than $10,000,000 of debt during the current calendar year? Yes No Don't Know < Previous | Next > Munipal Capital Markets Group, Inc. is a member firm of the Financial Industry Regulatory Authority (FINRA) and the Securities Investor Protection Corporation (SIPC).
Client Profile
Name of MCM Contact:
Entity's *Name:
Billing Address:
City: State, Zip:
Phone:
Fax:
Contact Person:
Title:
Type of Entity:
Date Incorporated:
Tax ID#:(optional)
*E-mail:
Brokers & Vendors
MCM Broker ID#
Property to be Financed
Seller's Name:
Address:
City, State, Zip
E-Mail Address:
Property
Equipment Cost:
Freight, Installation, other costs
Total Cost
Term Requested in months:
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