Lease Request Form - Rochford Langins Jarstad

Lease Request

"*" indicates required fields

Date

Email*

Landlord Information

Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Company Name*

Phone*

Tenant Information

Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Company Name*

Phone*

Permitted Use*

Property Information

Address*

Street Address Address Line 2 City State ZIP Code

Square Footage*

Dates

Commencement Date*

Termination Date*

Rent

Annual Base Rent*

Additional Rent*

Utilities*

Internet

Electric

Phone

Water/Sewer

Gas

Other

Billable Party*

First Last

Please list any Other Requirements/Conditions Below

Lease Request Form Instructions

Landlord Information

Name: Name of Landlord or Company acting as Landlord
Mailing Address: Mailing Address of Landlord
Phone Number: Contact Number for Landlord

Tenant Information

Name: Name of Tenant or Company acting as Tenant
Mailing Address: Mailing Address of Tenant
Phone Number: Contact Number for Tenant
Permitted Use: Enter specific use such as gym/retail shop/residence/etc.

Property Information

Address: Physical Address of Property
Square Footage: Square footage of rented space

Dates

Commencement Date: The date the lease begins and possession is delivered
Termination Date: The date the lease ends and possession is surrendered

Rent

Annual Base Rent: Total Annual Rent for Year 1
Additional Rent: Total Additional Rent for Year 1

Other

Billable Party: Who do we send an invoice to?
Please list any Other Requirements/Conditions Below: Signage/Assignments/NNN information if applicable/Special Considerations

Landlord Information

Name: Name of Landlord or Company acting as Landlord
Mailing Address: Mailing Address of Landlord
Phone Number: Contact Number for Landlord