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	Please Note: The Financing offered is applicable only to state governments, local governments, and public educational institutions. Some examples of these are:

	Cities Transit Authorities Airport Authorities Counties / Hospitals Colleges / Universities Parking Authorities	Parishes Law Enforcement State Parks & Rec Public Safety Townships / Villages Public School Districts

If you are an employee of one of the above who is responsible for the purchase and/or evaluation of electric vehicles and/or the financing of these products and services, please complete the following and submit. Please, due to volume of daily requests received, we ask that only serious inquiries be submitted. Please complete the information requested:

(* Required Fields)

Name / address of your entity: *

Contact name: *

Contact phone: *

Email: *

Fax number: *

In an effort to better assist you when we return your call, please check the boxes applicable to your situation.

My local government, state government, or public education institution:

1. Does not have electric vehicles but is seriously interested in the possibility.

2. Already uses electric vehicles and is looking to purchase other electronic vehicles.

3. Is seeking assistance in evaluating vehicles / financing for our situation.

4. Need to replace conventional vehicles with Electronic Vehicles and budgetary issues will not all cash purchases.

5. Is approved for a grant but doesn't have the matching funds required.

6. Has been mandated to acquire Electronic Vehicles and need financing due to lack of funds.

7. Has allocated funds to purchase Electronic Vehicles, but would like to see how many more we could afford by using municipal financing.

8. We are specifically interested in purchasing the following Synergy Products:

Type of vehicle wanted: *

Number anticipated: : *

Estimated cost: *