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 * RequiredState of IncorporationFEIN/Company Tax ID# * 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 * RequiredAnticipated Start Date - must be mm/dd/yyyy format * Required Anticipated Term3 months or less3 to 6 months6 to 9 months9 to 12 monthsEnd Date - must be mm/dd/yyyy format I am interested in: * RequiredCartIn-LineKioskVendingParking LotOfficeOtherWho 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: * RequiredDo 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 detailConcurrent with the submission of this application, please submit any photos if you have operated in any prior retail locations or of other retail presentations you plan to duplicate. This helps us understand how you have or will physically present your business. Send these photos to firstname.lastname@example.org * RequiredYes, I will send pictures to email@example.com.No, I do not have pictures to send.EmailThis field is for validation purposes and should be left unchanged.