Full Name (required)
Date of Birth
Previous Addresses with zip codes (If Less Than 3 Years At Present Address)
Drivers License # Of Applicant
Checking this box indicates my signature.
Co-applicant (if any)
I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.
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
Social Security #
All liquid assets must be accompained by verification
Cash (other than amounts shown in banks)
Cash in Banks (schedule 1)
Accounts Receivable (schedule 2)
Notes Receivable (schedule 2)
Stocks and Bonds (schedule 3)
Real Estate (schedule 4)
Other Investments (Schedule 3)
Networth of any Business Owned
Notes Payable to Others (Schedule 7)
Installment Loands Payable (Schedule 7)
Loands Against Life Insurance (Schedule 6)
Liens on Real Estate (Schedule 5)
Long Term Debts
Schedule1. Cash in Banks & Savings and Loan & Checking Accounts**
90 Day Avg Balance
**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
Schedule 3 Stocks and Bonds
Number of Shares
Amount Carries on My Books
Presents Market Value
Schedule 4 Real Estate (If additional space is necessary, attach separate sheet)
Address of Legal Description
Type of Property
Estimate Present Value
Schedule 5 Mortgages of liens on Real Estate
Name of Creditor
Schedule 6 Cost of Maintaining Office
Schedule 7 Notes Payable to Others
I, by checking the box 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.
Please complete in full. If you need more space to respond to any of the questions, please continue of a separate sheet of
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
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
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
Upload any documents you wish to attach