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RENTAL/CREDIT APPLICATION & CREDIT REPORT RELEASE FORM

The following information is provided to the Landlord for the purpose of verifying Credit History of the named applicant.

FULL NAME__________________________________________________________________________

DATE OF BIRTH____________________________________STATE_________________

SOCIAL SECURITY #________________________________

HOME ADDRESS_________________________________CITY______________STATE_____ZIP___________

HOME PHONE:__________________________FAX: __________________________

BUSINESS PHONE: __________________________FAX: __________________________

PREVIOUS ADDRESSES WITH ZIP CODES (IF LESS THAN 3 YEARS AT PRESENT ADDRESS)
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
___________________________________________________________________________________________________

DRIVER’S LICENSE # OF APPLICANT_________________________STATE______

___________________________________ _______________________
Signature Date

CO-APPLICANT (if any)____________________________________________________________

DATE OF BIRTH____________________________________STATE_________________

SOCIAL SECURITY #________________________________

HOME ADDRESS_________________________________CITY______________STATE_____ZIP___________

HOME PHONE:__________________________FAX: __________________________

BUSINESS PHONE: __________________________FAX: __________________________

PREVIOUS ADDRESSES WITH ZIP CODES (IF LESS THAN 3 YEARS AT PRESENT ADDRESS)
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
___________________________________________________________________________________________________

DRIVER’S LICENSE # OF APPLICANT_________________________STATE______

___________________________________ ______________________
Signature Date

Application Authorization:
This is to clarify that all information provided in this Credit Application is, to the best of my (our) knowledge, accurate and truthful. I (we)
authorize Great American Capital to investigate and verify all information through a Credit Report or other inquiry.

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CONFIDENTIAL FINANCIAL STATEMENT

Name _________________________________________ Social Security # _______________________________

Address _________________________________________ Business Ph ________________________________

_________________________________________________ Residence Ph ________________________________

Occupation ____________________________________ Employer ________________________________

Employer’s Address _____________________________________________________________________________________

Spouse’s Name _________________________________ Social Security # ________________________________

Address _________________________________________ Business Ph ________________________________

_________________________________________________ Residence Ph ________________________________

Occupation _________________________________ Employer ________________________________

Employer’s Address _____________________________________________________________________________________

ASSETS
ALL LIQUID ASSETS MUST BE ACCOMPANIED BY VERIFICATION

Cash (other than amounts shown in banks) $_________________ Automobiles $_________________

Cash in Banks (Schedule 1) $_________________ Other investments (Schedule 3) $_________________

Accounts Receivable (Schedule 2) $_________________ Personal Property $ ______________

Notes Receivable (Schedule 2) $_______________ Net Worth of any Business Owned

Stocks and Bonds (Schedule 3) $_______________ (Please include financial statement) $______________

Real Estate (Schedule 4) $_________________ Other Assets $________________

Sub Total $_______________ Sub Total $______________

Total $______________
LIABILITIES

Notes Payable to Others (Schedule 7) $_________________ Loans Against Life Insurance $_________________
(Schedule 6)

Installment Loans Payable (Schedule 7) $_________________ Other Liabilities $_________________

Accounts Payable $_________________ Liens on Real Estate (Schedule 5) $ ______________

Taxes Payable $_________________ Long Term Debts $_________________

Sub Total $_______________ Sub Total $______________

Total $______________

Net Worth $______________

Salary $_________________ Taxes & Assessments $_________________

Spouse’s Salary $_________________ Income Taxes $_________________

Dividends $_________________ Child Support/ Alimony $ ______________

Interest $_________________ Mortgage Payments $_________________

Commissions $________________ Contract Payments $_________________

Rentals $_______________ Insurance $_______________

Other $_______________ Other $_______________

Total $_______________ Total $_______________

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SCHEDULE OF ASSETS

Schedule 1 Cash in Banks & Savings and Loan & Checking Accounts **
Bank Name 90 Day Avg Balance Account # Balance

Total $_______________
**For each account, submit a verified statement from each banking institution, to include Name of Account, Current Balance, Account
Number, Length and Specific Dates of Account. The accounts must have been open and on deposit for a minimum of ninety (90) days
prior to the date of application.

Schedule 2 Receivables
Name of Debtor Collateral Payments Maturity Date Unpaid Balance

Total $_______________
Schedule 3 Stocks and Bonds
# of Shares Description Amount Carries on My Books Presents Market Value

Total $_______________
Schedule 4 Real Estate (If additional space is necessary, attach separate sheet)
Address of Legal Description Type of Property Monthly Income Original Cost Estimated Present Value

Total $_______________
Schedule 5 Mortgages of liens on Real Estate
Name of Creditor Payments Unpaid Balance

Total $_______________
Schedule 6 Cost of Maintaining Office
Rent __________________ Utilities __________________
Telephone __________________ Clerical Help __________________
Other (Describe) __________________
Sub Total Sub Total
Total $_______________
Schedule 7 Notes Payable to Others
Name of Creditor Address Payments Collateral Unpaid Balances

Total $_______________

I, by signing and filing this application, authorize any person or institution to which reference is made be me is connection with the
application, to release or divulge to the Landlord or its representative any information I the possession of such person or institution
regarding me. I hereby approve any investigation on my credit background.

Signature _____________________________________________ Date _______________________________

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PROSPECTIVE TENANT QUESTIONNAIRE

Please complete in full. If you need more space to respond to any of the questions, please continue of a separate sheet of
paper.

Individual(s) ____________________ Corporation ____________________ LLC ____________________

What kind of business do you propose to operate at the center?

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

What is your current profession?:__________________________________________________________________________________

What is your spouse’s current profession?:__________________________________________________________________________

Will either you or your spouse be leaving your current position to operate this business?

____________________________________________________________________________________________________________

How will you operate your new business at the proposed location? Who will manage? How many employees will you have?

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

What is your experience at operating such an enterprise? (Please provide specifics)

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

What improvements do you plan to make to the Premises (fixtures, carpet, etc.) and what cost? How will you pay for these
improvements?

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

Describe your anticipated start-up operating expenses at the new location and list amounts (include inventory, supplies, initial payroll
costs, insurance, signage, etc. (attach additional sheet if more room is required to answer these questions.)

_____________________________________________________________________ $__________________________

_____________________________________________________________________ $__________________________

_____________________________________________________________________ $__________________________

_____________________________________________________________________ $__________________________

_____________________________________________________________________ $__________________________

_____________________________________________________________________ $__________________________

_____________________________________________________________________ $__________________________

Total Start-Up Expenses: $__________________________

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How will you pay for your start-up expenses?

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

Do you have any other comments of information that you feel the Landlord should take into account in evaluating your proposed store or
restaurant?

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

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