Specialty Leasing Application Form Specialty Leasing We would love to hear from you! Please fill out this form and we will get in touch with you shortly. First Name * RequiredLast Name * RequiredCompany Name * RequiredStreet Address * RequiredStreet Address 2City * RequiredState * Required-- Select --AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingZIP * RequiredEmail Address * Required FaxHome Phone * RequiredCell Phone * RequiredWork Phone * RequiredCommencement Date - must be mm/dd/yyyy format * Required End Date - must be mm/dd/yyyy format I am interested in: * RequiredRMUKioskIn-line SpaceWho is your target customer?Gender * RequiredMaleFemaleMale/FemaleAge * Required-- Select --Under 1818-2425-3435-4445-54Over 55Income Level * Required-- Select --Under $15,000$15,000-$24,999$25,000-$34,999$35,000-$49,999$50,000-$74,999$75,000-$99,999$100,000 or moreProduct / Concept InformationWhat will be your average price point? * RequiredWhat sales volume would you project for your concept?Monthly Sales * RequiredAnnual Sales * RequiredIs your merchandise: * RequiredHand-crafted by yourselfWholesaledFranchisedPlease describe in detail your concept & merchandise:Do you have established resources / suppliers for the product you will sell? * RequiredYesNoHow long does it take to receive or produce your product? * RequiredAttach image of product or RMU File uploadAre you currently operating a business?Are you currently operating a business? * RequiredYesNoHow many locations?How many years have you operated this business?Have you operated any other businesses: * RequiredYesNoHave you operated a business in any other mall before?LocationDatesTypePermanentTemporarySalesLocationDatesTypePermanentTemporarySalesLocationDatesTypePermanentTemporarySalesLeasing QuestionsProposed Merchandise Concept/themePlease describe in detailWould you like a product image mailed to you? * RequiredYesNoEmailThis field is for validation purposes and should be left unchanged.