Residency Applicant Form
Today's Date
-
Month
-
Day
Year
Date
Applicant Details
Company name
Contact Number
Format: (000) 000-0000.
Company Email
example@example.com
Website URL
Office Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Business Organization Type
Corporation
Partnership
Sole Proprietorship
Year the Company was founded (since)
e.g since 2003
Number of Employees
Business Type
International
Local
Nature of Business/Trade
Fitness/Coach
Retailer
Professional
Well-being
Beauty
Consultancy
Other
Which eclat location are you interested in?
Troy
Piqua
Tipp City
All
How often are you looking to use the space?
Once or twice a month
5 Days a week
Once a week
2-3 times a week
Other
Company Description
Accepted Payment Method
Check, bank transfer, purchase order, credit card
Contact Person Details
Residency Business Representative Name
First Name
Last Name
Business Representative Email
example@example.com
Business Representative Signature
Date Signed
-
Month
-
Day
Year
Date
Print Form
Submit
Submit
Should be Empty: