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Business Organization and Credit Information
Partnership or Sole Proprietor


Name of Entity




Telephone Number


Fax Number


Email Address


Contact Person




Tax ID#


Form of Business:
       □Partnership                          □Sole  Proprietor                     □ Other (please describe)

Years in Business




Names and Addresses of Each Partner or Sole Proprietor


Current Value of Business

Role in Lease Operations


















Credit Information

1) Has the prospective Tenant ever defaulted from or been terminated from lease, or been forbidden from contracting by a public agency or private company?

                                    □ YES                                                  □ NO

2) List any Foreclosures, Bankruptcies, Transfers in Lieu of Foreclosure and/or Work Out/Loan Modification Transactions during the past 10 years. (If none, so indicate).


Name of Property


Property Type

Approximate Loan Amount


Year of Event



















Attach an explanation of circumstances, including resolution, bankruptcy, plan, and/or other documentation as appropriate.

3) Describe any fines or penalties levied by government agencies during the past 10 years. (If none, so indicate).

4) Describe any pending litigation or current lawsuits (other than those covered adequately by insurance) which if adversely resolved would materially impact the financial position of the Prospective Tenant.

5) Attach:

i)  Personal Financial Statements of all owners, partners, and key principles of the parent company, if applicable. (Audited).

ii)  Latest Financial Statement for business for past 2 years. (Audited).

iii) Credit Reports for the entity and key principals, from a major credit reporting company such Equifax, Dunn & Bradstreet.