Online Long Term Device Loan Application

Before You Submit

You will need a digital copy of the following supporting documents prior to submitting your online application.

  1. A formal, written quote on a vendor’s company letterhead, including ordering information, the requested device(s), total cost of device(s) - including taxes and shipping, and vendor name.

  2. Proof of income.

    • If self-employed, attach your IRS tax returns (including all schedules) for the past two years.

    • If employed, attach two months of your most recent pay stubs from your employer(s).

    • If you receive SSDI or SSI, attach your most recent award letter that you received showing your benefits income.

      **If you have additional income such as rental, child support, etc, acceptable documentation includes:

      • a) copies of court documents verifying this income.

      and/or

      • b) copies of IRS tax returns (including all schedules) for the past two years.

  3. Proof of Massachusetts residency. You only need a copy of one of the following.

    • Driver’s license

    • Voter’s registration

    • Utility bill in your name

    • Non-driver’s ID

  4. Acceptable documentation of disability. You only need a copy of one of the following.

    • A signed doctor’s letter.

    • SSDI or SSI benefits award letter.

In addition to including your supporting documents, please make sure that you also…

  1. Complete all required sections of the application.

  2. Sign and date the Certification & Release Statement and the Lease Agreement.