Lease Application

Lease Application
CREDIT REVIEW

Prospective Tenant:

Thank you for your interest in leasing space with Dinerman Group, LLC. In this lease application, we perform a thorough credit valuation of our tenants and request that you provide us with the following:

Entities:
- Complete a Lease Application (Form included)
- The previous two years’ year-end balance sheet and income statement
- Most recent year-to-date balance sheet and income statement
- Build-out budget for proposed space (updated and more specific as we move to lease execution)
- Business Plan (if a start-up, a forecast of income and expenses should be made showing the first year(s) of operation, noting funding sources)
- $75 Lease Application Fee (non-refundable) paid by check or online at dinerman.twa.rentmanager.com/applynow
Individuals/Guarantors (personal guarantees will be required if not an existing business or an inadequate signing entity):
- Complete Lease Application (Form included)
- Last two years’ personal tax returns (support schedules unnecessary)
- Personal financial statement (form included)
- Supporting documentation for any listed assets on your personal financial statement (recent bank and brokerage statements, real estate tax assessments, etc.)
- Copy of current Driver’s License
- $75 Lease Application Fee (non-refundable) paid by check or online at dinerman.twa.rentmanager.com/applynow
All information will be kept strictly confidential. Timely submission of ALL documentation will hasten the leasing process.

900 Circle 75 Parkway

Suite 250

Atlanta, GA 30339

Fax: (404) 631-6352

Justin@dinermangroup.com

We appreciate the opportunity to serve your needs.

Best Regards,
Dinerman Group, LLC

PROSPECTIVE TENANT CREDIT APPLICATION
COMPANY NAME:
Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Business Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email Address:
example@example.com
Years in Business:
Years at Current Location:
Size of Current Premises:
Current Rent:
Number of Employees:
Present Landlord:
Landlord's Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Proposed Use of Premises:
Will any Hazardous Materials be Stored or used on the Premises?

What type of business do you have?

A. SOLE PROPRIETORSHIP
Owner's Name:

First NameLast Name
Owner's Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Residence Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Do you Own or Rent?
For How Long?
Social Security No.:
Driver's License No.:
B. PARTNERSHIP
How many partners do you have?
Name:

First NameLast Name
Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Social Security No.:
Name:

First NameLast Name
Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Social Security No.:
C. CORPORATION
Federal Tax ID:
Date Incorporated:

MonthDayYear
Date
State of Incorp.:
Parent Corp.:
Division/Subsidiary of:
How many Corporate Officers:
Name:

First NameLast Name
Title:
Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name:

First NameLast Name
Title:
Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

By signing below, you hereby declare that the representation of facts contained in the foregoing application are considered part of the lease and are true and correct. If any information herein contained is false, the lease made on strength of this application may, at the option of Landlord, be terminated at any time. By signing below, you authorize the Landlord to verify the above statements including but not limited to, business and individual credit information, now or any time during the lease term.
Signature:
Date:

MonthDayYear
Date
Name:

First NameLast Name
Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.

LEASE GUARANTOR
Lease Guarantor:
Social Security No.:
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Lease Guarantor:
Social Security No.:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

BANK REFERENCES
Checking:
Branch:
Account No.:
Savings:
Branch:
Account No.:
CREDIT REFERENCES
Credit Reference #1:
Account No.:
Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Contact:
Credit Reference #2:
Account No.:
Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Credit Reference #3:
Account No.:
Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Credit Reference #4:
Account No.:
Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.

FINANCIAL INFORMATION
Please select and upload the ff. documents:
2 Years of Business financial statements, including balance sheet and income statements, prepared by and independent account.

Cancelof
Most recent year-to-date balance sheet and income statement.

Cancelof
Build-out budget for proposed space (updated and more specific as we move to lease execution)

Cancelof
Business Plan (if a start-up, a forecast of income and expenses should be made showing the first year(s) of operation, noting funding sources)

Cancelof
Authorization for entering into the transaction:

Cancelof
2 Years of personal tax returns:

Cancelof
A personal financial statement, prepared by an independent accountant:

Cancelof
Verification of current assets - copies of investment accounts, banking references:

Cancelof
Copy of current Driver's License

Cancelof

PERSONAL FINANCIAL STATEMENT

Answer all questions using "no" or "none" where necessary.

Please begin by completing schedules on reverse side.
PERSONAL INFORMATION
Name:

First NameLast Name
Date of Statement:

MonthDayYear
Date
Birthdate:

MonthDayYear
Date
Social Security No.:
Home Address (Include Apt.):

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How long?
Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Fax Number:
Please enter a valid phone number.Format: (000) 000-0000.
Email Address:
example@example.com
Business/Employer:
Title/Position:
How long?
Business Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Do you have any dependents? If yes, list ages below:
Do you have a will? If yes, name of executor:
Have you ever taken bankruptcy? If yes, explain:
Are you a defendant in any suits or legal actions?
Joint statement, list names of individuals whose assets, liabilities and income are included:
Present Landlord (if applicable) Address & Phone Number:

ASSETS
Cash, on hand and unrestricted in banks from below #1
$
Cash, on hand and unrestricted in banks from below #2
$
Cash, on hand and unrestricted in banks from below #3
$
Accounts/Notes-receivable (Schedule 2)
$
Cash surrender value life insurance. Do not deduct loans. (Schedule 3)
$
Other stocks and bonds (Schedule 4)
$
Real Estate at cost or market value (Schedule 4)
$
Automobiles #1
$
Automobiles #2
$
Automobiles #3
$
Other Assets #1
$
Other Assets #2
$
Other Assets #3
$
Total Assets in $

LIABILITIES
Notes payable to banks (Schedule 1)
$
Notes and accounts due others (Schedule 2)
$
Loan(s) against life insurance (Schedule 3)
$
Brokers margin accounts
$
Taxes accrued but unpaid
$
Mortgages payable on real estate (Schedule 5) #1
$
Mortgages payable on real estate (Schedule 5) #2
$
Mortgages payable on real estate (Schedule 5) #3
$
Other liabilities - itemize #1
$
Other liabilities - itemize #2
$
Other liabilities - itemize #3
$
Total Liabilities in $

Schedule 1

Supplementary Schedules (Take totals to front) Attach additional pages if necessary

Debts/Credit Lines (Include home equity and any other open-end revolving credit, even if unused)

Rows	Name and address of bank	Endorsement of collateral (describe)	Credit Line	Original Amount	Unpaid Balance	Monthly Payment
#1
#2
#3
TOTAL

Schedule 2

Supplementary Schedules (Take totals to front) Attach additional pages if necessary

Accounts, Loans, and Notes Receivable

Rows	Maturity Name and address of debtor	Date	Amount Owing	Description or nature of debt	Description of security held	Repayment terms
#1
#2
#3
TOTAL $

Schedule 3

Supplementary Schedules (Take totals to front) Attach additional pages if necessary

Life Insurance

Rows	Face Amount Name and address of debtor	Beneficiary	Insurance Co. of Policy	Surrender Value	Loan Against Policy	Yearly Premium	Type of Policy	Is Policy assigned?
#1
#2
#3
TOTAL $

Schedule 4

Supplementary Schedules (Take totals to front) Attach additional pages if necessary

Stocks, Bonds and US Government Securities

Rows	Description of Security	Registed in name of	Face Value (bonds)No of shares (stocks)	Market Value/Share	Total Market Value	Pledged Yes/No	Listed (L) on NYSE,AMEXUnlisted (U)Government Security (G)
#1
#2
#3
#3
Total Listed $
Total Unlisted $

Schedule 5

Supplementary Schedules (Take totals to front) Attach additional pages if necessary

Real Estate

Rows	Description of Address to Include City and State	Title in Name of	Date acquired	Cost	Market Value	Tax Value	Original Amount	Unpaid Balance	Monthly Payment
#1
#2
#3
TOTAL $

Previous Credit References

Supplementary Schedules (Take totals to front) Attach additional pages if necessary

Real Estate

Rows	Name and Address	List Names of Banks, Finance Companies or Other Concerns where Credit has been Obtained	Date	Account Number	Type of Account	High Credit
#1
#2
#3
#4
#5
TOTAL $

Should be Empty:

Lease Application

LEASE GUARANTOR

BANK REFERENCES

CREDIT REFERENCES

FINANCIAL INFORMATION

PERSONAL FINANCIAL STATEMENT

PERSONAL INFORMATION

ASSETS

LIABILITIES

Schedule 1

Schedule 2

Schedule 3

Schedule 4

Schedule 5

Previous Credit References