Commercial Application

Credit and Background Information

Business Information

* Indicates required field

Full Legal Company Name *

Business License# *

City *

DBA *

Federal Employ. ID # *

Date Fictitious Bus. Name Filed *

Business Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Years in this Location *

# of Stores *

Location(s) of Stores *

If a Corporation, State of Inc. *

Name and Address of Agent for Service *

Name and Address of General Partners, if any: *

Name and Address of Limited Partners, if any: *

If an LLC, Name and Address of Members: *

If Individuals, Name and Address *

Years in Business: *

Person to Contact *

Nature of Business *

Please List All Bank(s): (Business & Personal)

Name of Bank *

Branch *

Phone Number *

Account Name *

Account # *

Account Type: *

Name of Bank *

Branch *

Phone Number *

Account Name *

Account # *

Account Type: *

Trade References, Business (if none, Personal)

Current Landlord's Name *

Phone Number *

Address *

How long as tennant *

Insurance Agency *

Phone Number *

Address *

Agent *

First

Last

Other Reference: *

Phone Number *

Address *

Comments *

Other Reference: *

Phone Number *

Address *

Comments *

Personal Information

Name *

First

Last

Address *

Previous Address, if less than 2 years *

Date of Birth *

Driver's Lic. (# and state) *

Employer *

Phone Number *

Occupation *

SSN *

Monthly Income *

Spouse's Information

Name *

First

Last

Address *

Previous Address, if less than 2 years *

Date of Birth *

Driver's Lic. (# and state) *

Employer *

Phone Number *

Occupation *

SSN *

Monthly Income *

Have you ever filed for bankruptcy?

Business *

Yes No

When: *

State filed: *

Chpt: *

Personal *

Yes No

When: *

State filed: *

Chpt: *

Have you ever been convicted of a felony? *

Yes No

If so, what felony and when? *

Mortgage Holder:

Personal: *

Account # *

Phone Number *

Address *

Contact: *

Personal: *

Account # *

Phone Number *

Address *

Contact: *

PLEASE ATTACH A CURRENT FINANCIAL STATEMENT AND COPIES OF FEDERAL TAX RETURNS FOR THE LAST 3 YEARS FOR EITHER THE BUSINESS OR YOURSELF (whichever is going to be shown as “Lessee” in the lease).

Upload File *

Max file size: 20MB

Emergency Contact *

Phone Number *

Address *

Information Concerning Existing Location:

Size of Current Facility/Office? *

Current Montly Rent *

Reason for acquirint new space? *

I HEREBY GIVE PERMISSION FOR THE INDIVIDUALS AND BUSINESS 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 MY 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 HERE GRANTED PERMISSION TO VERIFY ALL CREDIT/PERSONAL INFORMATION AND TO OBTAIN ANY CREDIT REPORTS IT DEEMS NECESSARY.

By Lessee:

Executed at: *

On: *

By: *

Name Printed: *

Title: *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Facsimile: *

Federal ID No.: *

Submit

Credit and Background Information

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