SHOPPING CENTER APPLICATION



LEASE APPLICATION

Personal Information and Financial Statement

(Please Fill Out Completely and Fax to 1-866-293-2988)

| |Center Name: | |

| |Use: | |

| |Space # & Size: | |

TO WHOM IT MAY CONCERN:

The following is submitted by the undersigned:

|Full Name: | |Age: | |

|Driver’s License #: | | |

|Address: | |City: | |State/Zip: | |

|Phone: | | Own | Rent |How Long: | |Number of Dependents: | |

|Present Employer: | |How Long: | | |

|Address: | |

|Phone: | |Position: | |

|Do you plan to leave this job within the next year? | Yes | No | |

|Spouse’s Full Name: | |Age: | |

|Driver’s License #: | | |

|Address: | |City: | |State/Zip: | |

|Phone: | |Position: | |

| Does your spouse plan to leave this job within the next year? | Yes | No | |

|Bank Address: | |Account No: | |

|Bank Address: | |Account No: | |

|Do you plan to or have you applied for a business loan? For how much? $______________.00 | Yes | No |

|Have either you or your spouse ever filed bankruptcy (either personally or as any entity)? | Yes | No |

|BALANCE SHEET: |

|Cash: | |Notes Payable – total owed | |

| | |(list on page 2) | |

|Stocks & Bonds (list on back) | |Accounts Payable: - total owed (list on page | |

| | |2) | |

|Notes/Accounts Receivable: | |Mortgages – total owed | |

| | |(list on page 2) | |

|Life Insurance (not full value, only | |Automobile – total owed | |

|surrender value) | | | |

|Real Estate – total value | |Income Taxes – accrued to date | |

|(list on page 2) | | | |

| | |Other: | | | |

|Automobiles: | | |INSURANCE | | |

| | | | | | | |

| | | | | | | |

| | | | | | |

|Personal Possessions: | | | | | |

|Other: | | | |

| | | |Total Liabilities: | |

| | | | | |

|Total Assets: | |NET WORTH | |

| | |(assets minus liabilities) | |

|ANNUAL INCOME & EXPENSES |

|Your Salary: | |Rent/Home Loan Payments: | |

|Spouse’s Salary: | |Payments on Notes Owed: | |

|Rental Income: | |Payments on Accounts Payable: | |

|Dividend Income: | |Payments for Taxes: | |

|Interest Income: | |Personal Living Expenses: | |

|Other: Business | |Other: Insurance+ Property Tax | |

|Total Annual Income: | |Total Annual Expenses: | |

| |

|STOCKS & BONDS- 401K |

|Description |Number of Shares |Original Cost |Present Value |

| | | | |

| | | | |

| | | | |

| | | | |

| | | | |

|TOTALS | | | |

| |

|REAL ESTATE MORTGAGES AND TRUST DEEDS: |

|Description |Original Cost |Present Value |Description |Monthly Payment |

| | | | | |

| | | | | |

| | | | | |

| | | | | |

| | | | | |

| | | | | |

|TOTALS | | | | |

| |

|NOTES & ACCOUNTS PAYABLE (DO NOT INCLUDE REAL ESTATE) |

|Description |Account Number |Amounted Owed |Present Value |

| | | | |

| | | | |

| | | | |

| | | | |

| | | | |

| | | | |

| | | | |

|TOTALS | | | |

The information contained in this Personal Information and Financial Statement is certified as true and accurate as of the date executed and the date delivered by the undersigned and you are authorized to conduct a credit and background check. It is understood that you intend to materially rely on this information if you enter into any lease, guarantee of lease, transfer of lease, or other agreement with this undersigned. Any attachment or additional pages are a part hereof.

|Date: | |

|Signature: |Social Security: |

|Spouse’s Signature: |Social Security: |

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