<form name="form1" method="post" action="cdo-mailer.asp">
<table border="0" cellspacing="0" cellpadding="3">
<tr>
<td class="bodytextbold" colspan="2">Customer Information:</td>
</tr>
<tr>
<td class="bodytext">Legal Name of Department:</td>
<td class="bodytext">
<input type="text" name="LegalNameOfDepartment" size="25" class="bodytext">
</td>
</tr>
<tr>
<td class="bodytext">Contact Name:</td>
<td class="bodytext">
<input type="text" name="ContactName" size="25" class="bodytext">
</td>
</tr>
<tr>
<td class="bodytext">Street Address:</td>
<td class="bodytext">
<input type="text" name="StreetAddress" size="25" class="bodytext">
</td>
</tr>
<tr>
<td class="bodytext">City:</td>
<td class="bodytext">
<input type="text" name="City" size="15" class="bodytext">
</td>
</tr>
<tr>
<td class="bodytext">State:</td>
<td class="bodytext">
<input type="text" name="State" size="15" class="bodytext">
</td>
</tr>
<tr>
<td class="bodytext">Zip:</td>
<td class="bodytext">
<input type="text" name="ZipCode" size="9" class="bodytext">
</td>
</tr>
<tr>
<td class="bodytext">E-Mail Address:(Mandatory)</td>
<td class="bodytext">
<input type="text" name="EmailAddress" size="25" class="bodytext">
</td>
</tr>
<tr>
<td class="bodytext">Do you have Microsoft Word?</td>
<td class="bodytext">
<input type="radio" name="HasMicrosoftWord" value="Yes" class="bodytext" checked>
Yes
<input type="radio" name="HasMicrosoftWord" value="No" class="bodytext">
No </td>
</tr>
<tr>
<td class="bodytext">FAX:</td>
<td class="bodytext">
<input type="text" name="FaxNumber" size="15" class="bodytext">
</td>
</tr>
<tr>
<td class="bodytext">Phone:</td>
<td class="bodytext">
<input type="text" name="PhoneNumber" size="15" class="bodytext">
</td>
</tr>
<tr>
<td class="bodytext">First Month of Fiscal Year:</td>
<td class="bodytext">
<input type="text" name="FirstMonthOfFiscalYear" size="15" class="bodytext">
</td>
</tr>
<tr>
<td class="bodytext">Type of Department:</td>
<td class="bodytext">
<select name="TypeOfDeparment" class="bodytext">
<option selected>City</option>
<option>County</option>
<option>District</option>
<option>Volunteer Corporation</option>
<option>Other</option>
</select>
</td>
</tr>
<tr>
<td class="bodytextbold" colspan="2">Truck Information:</td>
</tr>
<tr>
<td class="bodytext">Truck / Equipment Description:</td>
<td class="bodytext">
<input type="text" name="TruckEquipmentDescription" size="25" class="bodytext">
</td>
</tr>
<tr>
<td class="bodytext">Expected Order Date:</td>
<td class="bodytext">
<input type="text" name="ExpectedOrderDate" size="15" class="bodytext">
</td>
</tr>
<tr>
<td class="bodytext">Cost:</td>
<td class="bodytext"> $
<input type="text" name="Cost" size="15" class="bodytext">
</td>
</tr>
<tr>
<td class="bodytext">Down Payment:</td>
<td class="bodytext"> $
<input type="text" name="DownPayment" size="15" class="bodytext">
</td>
</tr>
<tr>
<td class="bodytext">Trade-In Allowance:</td>
<td class="bodytext"> $
<input type="text" name="TradeInAllowance" size="15" class="bodytext">
</td>
</tr>
<tr>
<td class="bodytext">Amount Financed:</td>
<td class="bodytext"> $
<input type="text" name="AmountFinanced" size="15" class="bodytext">
</td>
</tr>
<tr>
<td class="bodytext">Expected Delivery Date:<br>
<span class="smallbodytext">Months after Truck Order Date</span></td>
<td class="bodytext">
<input type="text" name="ExpectedDeliveryDate" size="4" class="bodytext">
</td>
</tr>
<tr>
<td class="bodytextbold" colspan="2">Chassis Information:</td>
</tr>
<tr>
<td class="bodytext">Early Chassis Payment:</td>
<td class="bodytext">
<input type="radio" name="EarlyChassisPayment" value="Required" class="bodytext">
Required
<input type="radio" name="EarlyChassisPayment" value="Optional" class="bodytext">
Optional </td>
</tr>
<tr>
<td class="bodytext">Chassis Price:</td>
<td class="bodytext"> $
<input type="text" name="ChassisPrice" size="15" class="bodytext">
</td>
</tr>
<tr>
<td class="bodytext">Chassis Discount:</td>
<td class="bodytext"> $
<input type="text" name="ChassisDiscount" size="15" class="bodytext">
</td>
</tr>
<tr>
<td class="bodytext">Earliest Chassis Delivery:<br>
<span class="smallbodytext">Months after Truck Order Date</span></td>
<td class="bodytext">
<input type="text" name="EarliestChassisDelivery" size="25" class="bodytext">
</td>
</tr>
<tr>
<td class="bodytextbold" colspan="2">Financing Information:</td>
</tr>
<tr>
<td class="bodytext">Desired Lease Term:</td>
<td class="bodytext">
<p>Option 1:
<select name="DesiredLeaseTerm_Option1" class="bodytext">
<option selected>3 Years</option>
<option>5 Years</option>
<option>7 Years</option>
<option>10 Years</option>
<option>12 Years</option>
<option>15 Years</option>
<option>20 Years</option>
</select>
<br>
Option 2:
<select name="DesiredLeaseTerm_Option2" class="bodytext">
<option selected>3 Years</option>
<option>5 Years</option>
<option>7 Years</option>
<option>10 Years</option>
<option>12 Years</option>
<option>15 Years</option>
<option>20 Years</option>
</select>
<br>
Option 3:
<select name="DesiredLeaseTerm_Option3" class="bodytext">
<option selected>3 Years</option>
<option>5 Years</option>
<option>7 Years</option>
<option>10 Years</option>
<option>12 Years</option>
<option>15 Years</option>
<option>20 Years</option>
</select>
</p>
</td>
</tr>
<tr>
<td class="bodytext">Preferred First Payment Date:</td>
<td class="bodytext">
<input type="text" name="PrefferedFirstPaymentDate" size="15" class="bodytext">
</td>
</tr>
<tr>
<td class="bodytext">Payment Frequency:</td>
<td class="bodytext">
<select name="PaymentFrequency" class="bodytext">
<option selected>Annual</option>
<option>Semi-Annual</option>
<option>Quarterly</option>
<option>Monthly</option>
</select>
</td>
</tr>
<tr>
<td class="bodytext" colspan="2">
<div align="center">
<input type="submit" name="Submit" value="Submit">
<input type="hidden" name="x_recipient" value="wmeyers@leasing2.com">
<input type="hidden" name="x_sender" value="webserver@leasingtofiredepartments.com">
<input type="hidden" name="x_subject" value="Formal Proposal Request">
<input type="hidden" name="x_redirecturl" value="form-thankyou.htm">
<input type="hidden" name="FormTitle" value="Proposal">
</div>
</td>
</tr>
</table>
</form>
<p> </p>
</div>
<p align="center"> </p>
</td>
</tr>
<tr>
<td class="bodytext" valign="top" bgcolor="#FFFFFF" colspan="2">
<hr width="100%" size="1" noshade>
</td>
</tr>
<tr>
<td class="bodytext" valign="top" bgcolor="#FFFFFF"><a href="javascript:history.back()"><<
Back</a></td>
<td class="bodytext" valign="top" bgcolor="#FFFFFF">
<div align="right"><a href="javascript:print()">Print This
Page</a></div>
</td>
</tr>
</table>
</td>
<td width="1" bgcolor="#666666"><img src="images/spacer.gif" width="1" height="1"></td>
</tr>
</table>
<table width="100%" border="0" cellspacing="0" cellpadding="5">
<tr>
<td bgcolor="#990000"><img src="images/spacer.gif" width="1" height="10
">
</td>
</tr>
</table>
</td>
</tr>
</table>
</div>
</body>
</html>
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