Phone: 330.666.7773
PO Box 429
Bath, OH 44210-0429
Fax: 330.666.8081

Commercial Lease Application Form

*Subject Property Address

*Business Name	*Federal ID#

Current Address

City	State	Zip Code

Current Landlord Name	Phone	How long?	Rent Amount

Previous Address

City	State	Zip Code

Previous Landlord Name	Phone	How long?	Rent Amount

Type of Business	Reason for leaving present location?

PERSONAL INFORMATION
Applicant's Name & Title	Age	*SS#

Spouse's Name	Age	SS#

MARITAL STATUS
Married how long?	Divorced how long?	Separated how long? Single?

ALIMONY/CHILD SUPPORT
Amount Paying	Amount Receiving

Home Address

City	State	Zip Code

Landlord Name	Phone	How long?	Rent Amount

Monthly Wages Before Taxes	After Taxes	Total Income Last Year

Checking Account Balance	Savings Account Balance	Stocks / Bonds / Employer Savings Plan

Amount of Any Additional Income and Source

Are You Presently A Party In A Law Suit?	Explain
Yes No
Previously Bankrupt?	Date	Reason
Yes No
LIST ALL OTHER PERSONS THAT WILL OCCUPY THE PREMISES, IN ADDITION TO THE ABOVE APPLICANTS
Name	Relationship

Name	Relationship

Name	Relationship

Name	Relationship

Whom to contact in case of an emergency?	Relationship	Emergency Contact Phone

Emergency Contact Address

APPLICANT(S) HEREBY AUTHORIZE LESSOR AND OTHER SOURCES TO RELEASE INFORMATION AND CREDIT RECORDS AT ANY TIME TO VERIFY INFORMATION PROVIDED AND ASSIST IN THE COLLECTION OF MONEY OWED
*Date	*Applicant's Signature

Date	Spouse's Signature

Date You Are Able to Occupy Premises	Home Phone	Work Phone

Mobile Phone	Additional Information You Wish To Provide (300 characters)

*Applicant's Email Address


* Fields Required