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Business Organization and Credit Information
Partnership or Sole Proprietor

 

Name of Entity

 

Address

 

Telephone Number

 

Fax Number

 

Email Address

 

Contact Person

 

Title

 

Tax ID#

 

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

Years in Business

 

 

OWNERSHIP

Names and Addresses of Each Partner or Sole Proprietor

Percentage
 Ownership

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

City/State

Property Type

Approximate Loan Amount

Lender

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.