In order to finance our products you must first be qualified for our finance program. Please fill out the following secure form which upon submittal will be forwarded to our sales staff at Cougar Mountain. We will contact you once we have evaluated the information you submit.

By submitting this form, you are giving Cougar Mountain Software permission to forward your application information to The LCS Company for application processing. All information submitted here will be via a secure transaction and will remain confidential.

Product You Wish To Finance Firm Name Telephone (incl. area code) Fax (incl. area code) Address (street) City State .Zip Firm Established: Mo Yr Type of Business Structure of Business (sole owner, partnership, corporation) Date of Incorporation Duns Person to Contact Title Phone (incl. area code) Email Principle or Officer Title Social Security Home Address Zip Bank References (exact branch) List all banks used for the last 5 years Account Number (Savings, checking) Officer to Contact Phone Number (incl. area code) Trade Reference or Term Debt (address not necessary) Account Number Phone Number (incl. area code) Contact Name Financed or Leased Equipment (Lender) Account Number Phone Number (incl. area code) Contact Name Equipment Description Estimated Payment Equipment Cost Excluding Tax Term