Tenant Lease Application

Personal Information

First Name

Last Name

E-mail of Applicant

Phone Number

Social Security Number

Date of Birth

Address of Applicant

Address Line 1

Address Line 2

City

State

Zip Code

Property Information

Desired Date of Occupancy

All monetary values are expressed in US Dollars.

Rental Property Address:
4830 Atlantic Blvd
Jacksonville, FL 32207

Square Footage: 308 Sq. Ft.

Length of Lease: 1 Year

Base Rent: $650 per month

Specified operating costs to be paid by the Tenant: Advertising, Internet, Utilities

Initial Security Deposit: $1,300 (First + Last Month)

Business Information

Tell us about your business operations.

Business Name

Current Address

Address Line 1

Address Line 2

City

State

Zip Code

Date Established

Number of Employees

Intended Use of Premises

Applying as

Sole Proprietor

Partnership

Corporation

LLC

Partner Information

First Name

Last Name

Home Address

Address Line 1

Address Line 2

City

State

Zip Code

Social Security Number

Driver's License Number

Banking Information

Banking Institution

Banking Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Phone/Mobile

Upload Proof of Income

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Upload Proof Liability Insurance

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Credit References

Please provide industry references from which you make purchases through credit accounts and additional requested documentation as indicated below.

Company Name

First Name

Last Name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Contact Number

Professional Reference

Company Name

First Name

Last Name

Phone

I agree that the information provided herein is true and correct.

I agree to allow Rebecca Black Immigration, P.A. to conduct a reference and credit check in order to consider this application for approval.

Personal Information

Property Information

Business Information

Banking Information

Credit References

Professional Reference

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