Commercial Application Form - Conti Business Brokers

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Commercial Tenancy Application
Premises:
Proposed Use:
Experience:
Applicant
ABN
ACN
Address
Street Address City ZIP / Postal Code
Date of Birth:
Mobile
Home
Work
Drivers License:
Expiry Date:
Company Name/ACN:
Trading Name/ABN:
Reg.Company Address:
Solicitor/ Firm Name:
Email/Telephone:
Bank/Financial Institution:
Branch
Contact/Bank Manager:
Email/Telephone:

Business History
How long have you been Trading?
Trading Name:
Name1
Phone
Name2
Phone
Name3
Phone
Personal References
Name1
Phone
Name2
Phone
Name3
Phone
Lease Details Requested
Rental: $
Term:
Commencement Date:
Set up Period:
Renovations/Modifications Required:

This application is subject to the lessor’s approval.
Declaration (All applicants to sign)

I / We the applicants, do solemnly and sincerely declare that I / We are not bankrupt or an undischarged bankrupt and affirm that the above information is true and correct in every detail. I / We have inspected the above premises and wish to take a lease for such premises.

I / We are aware that no access will be given prior to signing of the lease and acknowledge that the owner or agent has the right to reject this application without having to state any reason therefore.

Statement to individuals pursuant to the Privacy Act 1988
- a) The contact details of the Agent set out on page
- b) The personal information requested in this form is required to assess your tenancy application.
- c) Personal information supplied may be disclosed in the course of assessing your tenancy application.
- d) You are entitled upon request to have access to the personal information held by the Agent.
- e) If the personal information is not provided by you, then your application for tenancy may not be considered.
- f) By providing the personal information requested, you hereby consent to the collection, use and disclosure and transfer of such personal information in accordance with this statement and the National Privacy Principles established by the Privacy Act 1988.
Applicant Name/s:
Date
Witness Name:
Date

Assets & Liabilities Schedule
Name:
Address:
Assets
Liabilities
1) Cash
1)
2) Residential Property
2) Mortgage Loans
Address
3) Motor Vehicles
3) Finance Company Loans
Make / Model
4) Other Loans
Total Assets Value
Total Liabilities Value
Net worth
- I solemnly declare that all information provided is true and correct.
Signature