Email Address*

Legal Name Of The Organisation*(This will be the entity that will be the Credit)

Legal Address*

Total Amount to be Financed*

Currency*GBPUSDAUDSGP

CountryUnited KingdomSpainGermany

Finance Term & Structure*(i.e. 24, 36, 48 months, etc.) & (i.e. fair market value structure or capital finance)

Finance Start Date*(i.e. anticipated deal close date)

Physical Address(s) where assets will be located*(Please list Country, State, Province, City, Street Address etc. as applies. Attach if necessary)

Bill of Materials Involved / Detail of Assets and/or Services Financed*(i.e. Hardware, Software, Services, Support involved or End User Quote Detail)

Customer Type*

(Public (If Public – please provide stock symbol), Private, Government, etc.)*

For Private: Organization Financials – Most Recent 3 Years and any Quarterly Interims.*(Required for End User Credits on Opportunities Greater than €100,000)

Non-Standard Structure Requirements*(i.e. delayed payment, step payment, balloon payment, purchase lease back, etc.)

Any Other Deal Specific Requirements*

Ingram Micro Representative Contact Information*

Reseller / Integrator Representative Contact Information*