Full Legal Company Name Business License No. City DBA Federal Employee ID # Date Fictitious Business Name Business Address Telephone No. No. of Stores Years in this Location Where? Primary Company E-mail Address Please upload a photo of your Driver's License Name of Bank Branch Telephone No. Name on Account Account No. Type of Account Business Personal Last Name First Name Middle Personal E-Mail Addess Personal Phone Number Address City, State, and ZIP Previous Address Previous City, State and ZIP Date of Birth Driver's License Employer Employer's Telephone No. Employer's Address Occupation Social Security No. Monthly Income Are you married? Yes No Last Name First Name Middle Address Previous Address Date of Birth Driver's License Employer Telephone No. Employer's Address Occupation Social Security No. Monthly Income Have You Ever Filed For Bankruptcy? Business Yes No Personal Yes No Details Have You Ever Been Convicted Of A Felony? Yes No If so, when? If so, what felony? PERSONAL MORTGAGE Do you have a personal mortgage? Yes No Who owns your mortgage? Mortgage Account No. Mortgage Holder Telephone No. Mortgage Holder Address Contact Name Emergency Contact Name Telephone No. Address We'd like information concerning your existing space. Size of current space that this new one will replace? Current monthly rent? Reason for acquiring this new space? I HEREBY GIVE PERMISSION FOR THE INDIVIDUALS AND BUSINESSES LISTED ABOVE AS REFERENCES TO PROVIDE FINANCIAL AND CREDIT INFORMATION TO MY PROSPECTIVE LESSOR, HIS MANAGER AND/OR HIS BROKER. I ALSO HEREBY AUTHORIZE THE OWNER AND HIS/HER REPRESENTATIVES TO PERFORM A CREDIT CHECK ON MYSELF AND/OR COMPANY. THE REPRESENTATIONS OF FACT CONTAINED IN THIS APPLICATION ARE CONSIDERED PART OF THE LEASE AND ARE TRUE AND CORRECT. IF ANY INFORMATION HEREIN CONTAINED IS DISCOVERED TO BE FALSE OR MISLEADING, THE LEASE MADE ON THE STRENGTH OF THIS APPLICATION MAY, AT THE OPTION OF THE LESSOR, BE TERMINATED AT ANY TIME. IN ADDITION, THE LESSOR IS HEREBY GRANTED PERMISSION TO VERIFY ALL CREDIT/PERSONAL INFORMATION AND TO OBTAIN ANY CREDIT REPORTS IT DEEMS NECESSARY. Complete the following if you agree to the above statements. Executed at: On: Full Legal Name: Telephone Home Address By placing your initials here, you affirm that the information entered throughout this form is accurate to the best of my knowledge. Initials Send
