CUSTOMER FINANCE PROPOSAL
For Incorporated Businesses
UNIQUE PROPOSAL NUMBER
(For SFS use only)

1. SUPPLIER DETAILS

Supplier’s Name / BrightOn LED Lighting / Contact Name
Contact Telephone No. / 01273 530673 / Email Address
Supplier’s Address / / Postcode

2. CUSTOMER DETAILS

Registered Company Name
Trading Name / Contact Name
Contact Telephone No. / Email Address
Customer’s Address / Postcode
Nature of Business / Registered No.
Time in Business / Type of Business / Click HereLimited CompanyPublic SectorOther (Please specify)

3. NEW EQUIPMENT/PROJECT DETAILS

Technology type / LED Lighting
Equipment Make / Condition E.g. New, Used, Remanufactured) / Click Here NewUsedRemanufacturedOther (Please Specify)
Equipment Model / Serial No’s If available
Equipment Quantity / Equipment Operating Hours / Click HereWeeklyMonthlyAnnually
Industrial Sector
(Office use only) / Industrial Sub-Sector (Office use only)
Building Type / Click HereAgriculturalCommunication and TransportEducationGovernment EstateHealthcareHospitalityHousingIndustrialOfficeRecreational and CulturalWholesale and Retail Other (Please specify)
Description of Use
Please provide an overview of the project and any other relevant information about building type, age etc if relevant.
Product catalogue data attached / Yes No
If you are dealing with multiple technologies, please provide further details and / or attach information.

4. FINANCIAL DETAILS & TERMS

Equipment Price ex VAT / £ / Financing Term / Months
Installation Cost / £ / Payment frequency / Click HereMonthlyQuarterlyHalf Yearly Annually in Advance
Total amount financed / £
Type of agreement / Lease Loan / Customer’s payment method / Direct debit

5. ACCOUNT DEVELOPMENT MANAGER DETAILS (If known)

Contact Name
Telephone / Email Address

6. ENERGY SAVING PROJECT DETAILS incl. Energy Data and Savings Calculations

(Please complete the section below, or provide all of the data in a separate attachment(s))

Site Address
If different from the reg. address.
12 months energy data for site (Required)
(Usage in kWh, spend in £) / Usage
Electricity kWh
Gas kWh
Other kWh / Spend
Electricity £
Gas £
Other £
Bills attached (required): Yes No
Energy Saving Calculator attached (Required) / Yes No
The Energy Saving Project / Please provide a calculation showing how the energy savings will be achieved. This should clearly state any assumptions that you have used in the calculation.
Industrial or Business Sector / Click HereBeveragesBrewing & TobaccoChemicals Construction & Building ManagementExtraction IndustriesFinancial ServicesFood, Production & AgricultureHealthcare & LeisureHousehold & Consumer GoodsIndustrial & ManufacturingManufacture of Basic MaterialsPublic SectorRetail & Distribution Telecoms & MediaTransport & InfrastructureUtilities & WasteOther (Please specify) / Other:
Annual Operating Hours / Pre project hours / Post project hours
Fuel type / Fuel cost
(p / kWh) / p
Can you complete the project within 90 days? / Yes No If no, state number of days expected
Note: Applicants for Power Factor Correction, Biomass Heating, Plastic Injection Moulding, Autpmotive Spraybooths and Voltage Management should be made using the predefined template available on the Carbon Trust website.

7. EXISTING EQUIPMENT / INSTALLATION DETAILS

Equipment Make
Equipment Model / Serial No’s If available
Equipment Quantity / Equipment Operating Hours / Click HereWeeklyMonthlyAnnually
Description of Use
Additional Information
(E.g. Information that is relevant to the ESA. Alternatively please attach further information.

Please return this form and supporting information to: Energy Efficiency Financing, Siemens Financial Services Limited, Sefton Park, Bells Hill, Stoke Poges, Buckinghamshire SL2 4JS E-mail: .