LEASE APPLICATION

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Step 1 of 3

Today’s Date:

Personal Information

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Name

SS#

Date of Birth

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Residence Address

Zip/Post Code

Home Phone

Mobile Phone

Email Address

City, State/Province

Country

Business Phone

Fax Number

Marital Status

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Please indicate the names of all individuals (in addition to yourself) who will have a beneficial ownership in the lease.

(All individuals identified below as equity owners must also complete a Lease Application.)

Do you have an LLC that you will use for this lease?

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If you will be using an LLC is it already registered?

Are you the sole member of the LLC?

If the LLC is registered what is it’s name?

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Do you plan to devote your full time to this business?

Will this business be your primary source of income?

Will your spouse/partner be active in the business?

Have you ever owned a business?

Comments:

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Geographic Area of Interest:

County

I am: (Check all that apply.)

A citizen or national of the United States
An alien lawfully admitted for permanent residence
An alien authorized by the Immigration and Naturalization Service to work in the United States

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I am a national of(Country)

I am a citizen of(Country)

Non-citizenship will not be a bar to being awarded a lease.

Are you currently involved as a defendant in any litigation or arbitration proceeding?

Are there any contingent liabilities of any kind against you?

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Financial Statement

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Cash on hand or in bank($)

Autos($)

Total($)

Home($)

Personal Property($)

Stocks and Bonds($)

Retirement, 401(K), IRA, etc($)

Real Estate($)

Other

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Installment Notes & Contracts($)

Total Liabilities

Real Estate Loans($)

Bills Payable($)

Other

Total Assets (A)

Total Liabilities (B)

Net Worth (Subtract B from A)

Authorizations and Releases

I understand that CCO, LLC may be requesting information from various companies, financial and other institutions, universities, credit reporting agencies, professional and academic certification law enforcement agencies, former employers, and the military, and I hereby authorize such entities to release any information that they may have about me to CCO, LLC and its affiliates, its agents and designees, and release them from any liability arising out of or related to their release of such information. I authorize all financial institutions holding funds or other property on my behalf or on behalf of any business entity in which I hold a beneficial interest, whether or not identified in this Lease Application, to release all records including signature cards, statements and all documentation reflecting the source of deposited funds, whether the funds were received in the form of cash, credit, electronic fund transfer or wire transfer. I also authorize CCO, LLC, its affiliates and its agents and designees to obtain such credit and other civil and criminal investigative reports as they consider necessary to evaluate this Lease Application, and understand that these reports may contain information about my background, mode of living, character and personal reputation. This authorization is valid for any current and future reports and updates that may be requested. I further authorize CCO, LLC, its affiliates, its agents and designees to contact individuals or entities identified in this Lease Application, or whose names arise in connection with the civil and criminal investigative reports described above for purposes of obtaining character references and verifying the information contained in this Lease Application. I hereby authorize any individual or entity contacted by CCO, LLC and its affiliates, or its agent or designee to provide all requested information, and release them from any liability arising out of or related to their release of such information. Representations I certify that I have carefully read the Lease Application and it is complete, true and correct in all respects. I have been advised and understand that any misrepresentation or inaccuracy in the information provided by me will be grounds for termination of any Lease or any agreement that CCO, LLC and its affiliates may grant to me based on the information in this Lease Application. Notwithstanding this acknowledgment, I understand and agree that nothing contained in this Lease Application obligates CCO, LLC and its affiliates to grant me a Lease.