Lease Application Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form. - Step 1 of 3Today’s Date: *Personal InformationLayoutName *SS# *Date of Birth *LayoutResidence Address *Zip/Post Code *Home PhoneMobile Phone *Email Address *City, State/Province *Country *Business PhoneFax NumberMarital StatusSingleMarriedLayoutName of Spouse *Age *Spouse's SS# *Number of Children *Spouse's Date of Birth *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? *YesNoLayoutIf you will be using an LLC is it already registered? *YesNOAre you the sole member of the LLC? *YesNoIf the LLC is registered what is it’s name?LayoutDo 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:LayoutGeographic Area of Interest: *County *I am: (Check all that apply.) *A citizen or national of the United StatesAn alien lawfully admitted for permanent residenceAn alien authorized by the Immigration and Naturalization Service to work in the United StatesLayout I am a national of(Country) *I am a citizen of(Country) *Non-citizenship will not be a bar to being awarded a lease.NextPlease attach to this application following documents: *Driver's license or I.D. card with a photographOther government-issued identification (describe)Passport photo pageCertificate of United States CitizenshipAlien Registration Card with photographCertificate of NaturalizationLayoutDriver's license or I.D. card with a photograph * Click or drag files to this area to upload. You can upload up to 5 files. Certificate of United States Citizenship * Click or drag files to this area to upload. You can upload up to 5 files. Other Govt-issued Identification (Describe) * Click or drag files to this area to upload. You can upload up to 5 files. Alien Registration Card with photograph * Click or drag files to this area to upload. You can upload up to 5 files. Passport photo page * Click or drag files to this area to upload. You can upload up to 5 files. Certificate of Naturalization * Click or drag files to this area to upload. You can upload up to 5 files. What type of locations are you interested in?Convenience store with gasolineConvenience store without gasolineCommercial spaceReferencesLayoutNameAssociationCity, State, Country Tel. #LayoutNameAssociationCity, State, Country Tel. #LayoutNameAssociationCity, State, Country Tel. #Recent Employment History or Experience Owning a BusinessLayoutCompanySalaryYear(s)City, State, Country Tel. #Title or PositionLayoutCompanySalaryYear(s)City, State, Country Tel. #Title or PositionHave you ever owned a business before? *Business InterestsPlease identify all business enterprises in which you hold a beneficial ownership interest. The term "business enterprise" includes a corporation, association, partnership, business trust, sole proprietorship, or other business, the shares of which are not listed on a securities exchange or otherwise regularly traded. Under "legal form of business," please describe the type of business entity in which you hold an interest (e.g., corporation, partnership, etc.)LayoutName and Address of BusinessOwnershipLegal Form of BusinessCurrent ValueNature of BusinessLayoutName and Address of BusinessOwnershipLegal Form of BusinessCurrent ValueNature of BusinessHave you ever applied for or obtained credit under another name in the past ten years?YesNoWhat name(s)? *Have you ever been convicted of a felony or other crime involving moral turpitude?YesNo please state the name and address of the court and the date of conviction, and provide brief description of the charges for which you were convicted: *Have you ever filed for bankruptcy?YesNoLayout please provide discharge letter for the bankruptcy * Click or drag a file to this area to upload. MessageAre there any judgments pending against you that have not been satisfied?YesNoPlease state the name and address of the court, and the date and amount of the judgment: *PreviousNextAre you currently involved as a defendant in any litigation or arbitration proceeding?YesNoPlease state the name and address of the court, and provide a brief description of the allegations against you and the amount of the claim: *Are there any contingent liabilities of any kind against you?YesNoLayoutNotes Or Accounts Receivable Discounted Sold, or Assigned(US$) *As Guarantor For Other on Notes, Bonds, Contracts, Etc.(US$)Any Other Contingent Liabilities, Pending Lawsuits, Litigation. Please itemize and provide details.(US$)Financial StatementLayoutCash on hand or in bank($)Autos($)Total($)Home($)Personal Property($)Stocks and Bonds($)Retirement, 401(K), IRA, etc($)Real Estate($)OtherLayoutInstallment Notes & Contracts($)Total LiabilitiesReal Estate Loans($)Bills Payable($)OtherTotal 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.Submit