Rate Quote Request Form                         (today's date)

Rates quoted for all GS $Mart^® transactions must be valid for a period of 30 days. In the response please make sure you include a dated amortization schedule, following the format of the Payment Schedule Format, Provisions and Notes. The only way that an interest rate may be adjusted is if the provisions are included as part of the completed response with the blanks filled in. Your company's response (the dated amortization schedule) and the standard paragraph adding the State's designated Lender and incorporating the Terms and Conditions of GS $Mart into the contract legally bind your company to the contract.

Agency:                     

City:                                        Zip:

Contact Name:          

Title:                          

Phone:            

Fax:                            

E-mail:                       

Equipment Description (give accurate description)

 (New/Used/Refinance):       

Reason for acquisition:         

Estimated Delivery Date:    

Acceptance Test Period:      

Estimated Acceptance Date: 

Est. First Payment Date:      

Estimated Finance Amount (includes sales tax): 

Payment Frequency:

Month/ Quarter/ Semi-Annual / Annual (circle one)

Term (how many periods):    

Comments/Deadline:

Incomplete quotes/attachments will be disqualified.  If you have questions, contact me by VM or EM. DO NOT CONTACT THE CUSTOMER! Thank you.