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TENANT INFORMATION
Name
*
First
Middle
Last
Email
*
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MM slash DD slash YYYY
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Address Line 2
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Cook Islands
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Cyprus
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Gabon
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Panama
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Paraguay
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Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Current Employer
*
Business Phone
*
Former Employer
Do you have a co-tenant or spouse?
*
Please choose one
Yes
No
CO-TENANT OR SPOUSE INFORMATION
Name
*
First
Middle
Last
Email
*
Cell Phone
*
Home Phone
Birthdate
*
MM slash DD slash YYYY
Driver's License #
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
Home Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Country
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Current Employer
Business Phone
Former Employer
Relationship to Tenant
*
FINANCIAL STATEMENT—ASSETS
Assets: Cash in banks
Checking Account Balance
*
Checking Account Bank Name
*
Savings Account Balance
Savings Account Bank Name
Total Balance of Other Accounts
Other Account Bank Name(s)
Assets: Automobiles
How many automobiles do you own?
*
Please only include automobiles that are completely paid off.
Please choose one
0
1
2
3
4
5+
Auto 1: Value
Auto 1: Year
Auto 1: Make
Auto 1: Model
Auto 2: Value
Auto 2: Year
Auto 2: Make
Auto 2: Model
Auto 3: Value
Auto 3: Year
Auto 3: Make
Auto 3: Model
Auto 4: Value
Auto 4: Year
Auto 4: Make
Auto 4: Model
If 5+, please tell us about the other vehicles you own
Assets: Real estate
Homestead Value
Mortgage Company
Other Residential Real Estate Value
Total value
Commercial Real Estate Value
Total value
Rural Real Estate Value
Total value
Assets: Stocks & bonds
Marketable Stocks
Total value
Other Stocks
Total value
Savings Bonds
Total value
Other
Total value
Assets: Oil interests
Producing Properties
Total value
Other Oil Interests
Total value
Assets: Other
(e.g., mineral interests, natural gas)
How many other assets do you own?
*
Please choose one
0
1
2
3
4
5+
Other Asset 1: Value
Other Asset 1: Type
Other Asset 2: Value
Other Asset 2: Type
Other Asset 3: Value
Other Asset 3: Type
Other Asset 4: Value
Other Asset 4: Type
If 5+, please tell us about your other assets
TOTAL ASSETS
Your Total Asset Value
ANNUAL INCOME
Your 2024 Salary or Net Business Income
Job Plans
Please choose one
I intend to keep my current job and open this new business
I intend to leave my current job to open this new business
Other
If Other, please explain
*
FINANCIAL STATEMENT—LIABILITIES
Liabilities: Notes payable to banks & secured notes
List up to 2 notes payable to banks and/or secured notes
Amount Due
Bank Name
Original Loan Amount
Asset Used as Collateral
Add
Remove
Total amount due on all other notes payable to banks & secured notes
Liabilities: Credit cards & unsecured notes
List up to 2 credit cards and/or unsecured notes
Amount Due
Credit Card Name
Credit Card Limit
Add
Remove
Total amount due on all other credit cards & unsecured notes
(e.g., medical bills)
Liabilities: Real estate
I have...
*
Please choose one
A monthly mortgage payment
A monthly rental payment
No payment due
Monthly Mortgage Payment
Total amount
Monthly Rental Payment
Total amount
Other Residential Real Estate Payments
Total amount
Commercial Real Estate Payments
Total amount
Rural Real Estate Payments
Total amount
Liabilities: Taxes due
Total Annual Taxes Due
(automobile, personal, retail, commercial, etc.)
Liabilities: Due on automobiles
How many automobile payments do you make each month?
*
Please choose one
0
1
2
3
4
5+
Auto 1: Value
Auto 1: Year
Auto 1: Make
Auto 1: Model
Auto 2: Value
Auto 2: Year
Auto 2: Make
Auto 2: Model
Auto 3: Value
Auto 3: Year
Auto 3: Make
Auto 3: Model
Auto 4: Value
Auto 4: Year
Auto 4: Make
Auto 4: Model
If 5+, please tell us about your other automobile payments
Liabilities: Other
(e.g. personal bills)
How many other liabilities do you have?
*
Please choose one
0
1
2
3
4
5+
Other Liability 1: Monthly Amount Due
Other Liability 1: Description
Other Liability 2: Monthly Amount Due
Other Liability 2: Description
Other Liability 3: Monthly Amount Due
Other Liability 3: Description
Other Liability 4: Monthly Amount Due
Other Liability 4: Description
If 5+, please describe your other liabilities
TOTAL LIABILITIES
Your Total Liabilities
NET WORTH
Your Net Worth
BUSINESS HISTORY
Have you leased retail space for the purpose of operating a business?
*
Please choose one
Yes
No
If so, for how long?
Please include a date range
Are you relocating an existing store?
*
Please choose one
Yes
No
If so, what's the name of the existing store?
What is the current address of the existing store?
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Country
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Are you opening an additional location?
*
Please choose one
Yes
No
If so, how many other locations do you own and operate?
Is there any additional information regarding your experience within the business you wish to open that you would like the Landlord to be aware of upon the Lease Application review?
Authorization
*
The undersigned does hereby authorize The Genecov Group, Inc., its shareholders, directors, officers, employees, agents and contractors (collectively referred to as the “Creditor”) to obtain from time to time and all credit reports, information, and date from any and all sources that the Creditor deems appropriate and to copy, retain and utilize such information as necessary in order to fully review the credit-worthiness and solvency of _________________________________________ (jointly and collectively referred to as the “Applicant”.).
I warrant with and covenant to the Creditor that the undersigned has the full and complete requisite authority for the Applicant to execute and deliver this authorization pursuant to resolutions, power of attorney, bylaws, or other written agreements executed or adopted by the Applicant. This financial statement and lease application are submitted for the purpose of lease consideration and the information within represents a true, complete, and correct representation of the Applicant’s financial condition as of the date below.
Finally, the undersigned acknowledges that Creditor is prohibited form divulging the information obtained by Creditor to the undersigned or Applicant due to the Proprietary nature of the information.
I agree to this authorization.
Email
This field is for validation purposes and should be left unchanged.
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