Business Organization and Credit Information

Complete separate form for the submitting corporation and the parent corporation (include all partners in a joint venture).

Name of Entity




Telephone Number


Fax Number


Email Address


Contact Person




Tax ID#


State of Incorporation


Date of Incorporation




Number & Type of Shares or Percentage of Ownership

Current Value of Investment

Names & Addresses of those with controlling interest or key principals of corporation






Total of All



Total Shares




Corporate Officers and Board of Director


Title and/or Affiliation











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.