Lease Application (Fill in the ppropriate fields)

BUSINESS INFORMATION

Name of Business

Business Phone

Type of Business:
—Please choose an option—IndividualPartnershipCorporation

Current Address

Number of Years

Current Monthly Rent

Number of years in business:

Federal Tax ID Number

Name of Local Contact

BUSINESS OWNER'S INFORMATION

Name

Address

Home Phone

INCASE OF EMERGENCY, PLEASE NOTIFY:

Name

Telephone

Trade Reference

Telephone

NON DISCRIMINATION.

It is understood that this property is offered without respect to race, color, religion, sex, handicap, familial status or national origin. I, undersigned authorize Prime Realty Group, inc. (or its agents) to review the credit profile of the above named firm for use in conjunction with the application for Lease. I release all persons or firms, referenced above, from any liability in response to questions asked to this application.

Signature

Date

Print Name

Title

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