SHOPPING CENTER APPLICATION

Shopping Center Name & Location:____________________________________________________________

____________________________________________________________
Project Opening Date:_______________________________________________________________________
Applicant Name:___________________________________________________________________________
Applicants Current Address: ________________________________________________________________
_________________________________________________________________________________________
Previous Address: __________________________________________________________________________
_________________________________________________________________________________________

Home Number: _______________Cell :______________ Emergency Contact & Number_________________

________________________________________________________________________________________

Date of Birth:____________________

Email Address:___________________________________________

Social Security Number:_____________________________________________________________________

Employed By:_____________________________________________________________________________

Work Address:_____________________________________________________________________________

How Long:____________ Monthly Income:_____________________________________________________

Supervisors Name:_________________________________ Position:________________________________

Work Telephone Number:__________________ Cell Phone Number:_________________________________

Spouses (Partner) Name:_____________________________________________________________________

Spouse (Partner)Email Address:________________________________________________________________

Soc. Sec. No._____________________________________ Date of Birth:______________________________

Employed By:______________________________________________________________________________

Work Address:_____________________________________________________________________________

How Long:_____________________________________ Monthly Income:____________________________

Supervisors Name:______________________________ Position:___________________________________

Work Telephone Number: ___________________________________________________________________

Cell Phone Number:__________________ Emergency Contact & Number:_____________________________

__________________________________________________________________________________________

Signature Name(s) to be listed as Tenant(s) on Lease and the

Corporation Name or Name(s) to be listed as Tenant(s) on Lease:
__________________________________________________________________________________________
__________________________________________________________________________________________

Business or Trade Name:

__________________________________________________________________________________________

__________________________________________________________________________________________

Trade References:
Name

Address

Telephone

__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

Bank References:

Account #

__________________________________________________________________________________________
__________________________________________________________________________________________

Personal References:
Name

Address

Telephone

__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

Credit References:
Name:___________________________________________________ Acct. #___________________
Name:___________________________________________________ Acct. #___________________
Name:___________________________________________________ Acct. #___________________

Income Information:
Salary:
$__________________
Bonus/Commissions $__________________
Dividends:
$__________________
Real Estate Income: $__________________
Other Income (alimony, child support or any income you wish to have considered as a basis for paying
obligations):
$__________________
TOTAL INCOME:

$__________________

It is understood and agreed that the security deposit money may or may not be deposited into an interest bearing
account until the execution of the Lease by both parties, which interest, if any, will accrue to the holder for
administrative expenses. It is also understood that the Premises will not be released until a Lease Agreement
has been executed by both the Landlord and the Tenant.
The representation of fact contained in this application are considered part of the Lease and are true and correct.
If any information herein contained is discovered to be false or misleading, the Lease made on the strength of
this application may, at the option of the Landlord, be terminated at any time. Additionally, _______________,
the Landlord and/or their Agent, ___________________________, is hereby granted permission to verify all
credit/personal information and to obtain any credit reports it may deem necessary. Please enclose a nonrefundable application fee of $25.00, payable to __________________________________________________.

Applicant:

Applicants Spouse (Partner):

____________________________________
Printed Name

_______________________________________
Printed Name

____________________________________
Signed Name

_______________________________________
Signed Name

_________________
Date

_________________
Date