Office for Rent Member Application from Urban Office

Suite No^*

Urban Office Location^*

Desired Term of Membership (Months)^*

Desired Start Date^*

Applicant

Legal Business Name^*

DBA (Business Trade Name)

Business Classification

Taxpayer ID#

State where registered

Year organized

Type of Business^*

Number of people to use/occupy Urban Office^*

Primary Contact Person^*

Phone Number^*

Email^*

Is the Primary Contact Person the same as the Billing Contact Person?^*

If no, please provide the Billing Contact Person's information:

Billing Contact Person

Phone Number

Home Address^*

Street^*

City^*

State^*

Zip^*

How did you hear about Urban Office?^*

If other, please specify:

Do you intend to rent furniture?^*

If yes, please provide specific furniture items requested:

Has Applicant Ever

Filed for Bankruptcy?^*

Been convicted of a crime? If yes, provide location, year and type of conviction.^*

Is any occupant a registered sex offender? If yes, provide the location, year and type of conviction.^*

Is there additional information Applicant wants considered?^*

If the answer to any of the questions above is YES, please provide specifics and additional information below:

Business Rental History (Two years history or more required)

Present Office Address

Street

City

State

Zip

This office is

Present Office Type:

If Other, please specify

Monthly Rent/Mortgage

Occupied from

Occupied to

Reason for leaving

Landlord or Loan Servicer

Mortgage or Rental Account

Contact Email

Prior Office Address

Street

City

State

Zip

This office was

Monthly Rent/Mortgage

Occupied from

Occupied to

Reason for leaving

Landlord or Loan Servicer

Mortgage or Rental Account

Contact Email

Guarantors

1.

Name^*

Title^*

Date of Birth^*

Email^*

Home Address

Street^*

City^*

State^*

Zip^*

2.

Name

Title

Date of Birth

Home Address

Street

City

State

Zip

Certification

I hereby certify that the information provided in this Membership Application is complete, true, and correct. I understand that Urban Office will rely on the information provided in this Membership Application in making a decision to enter into an agreement with me, or in the event of a default under any agreement with me. I hereby authorize Urban Office and its agents to obtain credit reports and criminal background reports, and verify my credit standing and financial stature, rental history, and employment history. I hereby agree to release, indemnify and hold Urban Office, including Urban Office’s employees, agents, and contractors, harmless from all statutory, common law, and all other liability claims related to Urban Office’s inquiries into, or use of, the information provided in this Membership Application, as well as Urban Office’s use of any information obtained from third parties in connection with this Membership Application.

Printed Name^*

Title^*

Date^*

Drivers License^*

Please upload driver's license

Member Application

Applicant

Home Address*

Has Applicant Ever

Business Rental History (Two years history or more required)

Present Office Address

Prior Office Address

Guarantors

1.

2.

Certification

Home Address^*