Form Center

2. Information provided is confidential, in accordance with Connecticut Law.
4. Business Name
   If applicable
6. Property Address
8. City
9. State
10. Zip Code
12. Form Preparer/Position
14. Phone Number
16. Type of Business

    1. New Car Dealership (Full Service)
    2. Used Car Dealership (Full Service)
    3. Used Car Dealership (Limited Service)

    1. Gasoline Service Station and Repair
    2. Gasoline Service Station and Retail
    3. Auto Repair
18. Total Leased Building Area
20. Percentage Finished
    Office, Showroom, Retail
22. Percentage Service/Shop
24. Percentage Warehouse/Storage
26. Is total land area of property address included in lease?

    1. Yes
    2. No
28. If not, how much is included?
30. Annual Base Rent for (Year)
31. Additional Rent
    (Percentage, overage, etc.)
32. Total Rental Income for (Year)
34. Operating expenses paid by
35. Landlord
36. Tenant
38. Real Estate Taxes
42. Insurance
46. Repairs & Maintenance
50. Administrative, Legal, Accounting
54. Reserves
58. Utilities
62. Trash/Snow Removal
66. Total Operating Expenses
70. For additional comments and/or information (original lease term, escalation rates, renewal options, purchase option, etc.), please attach a separate page.
72. Additional Uploads
74. e-Signature
75. Date
    Date
Leave This Blank:


77. 1. Receive an email copy of this form.
78. Email address

    This field is not part of the form submission.

79. Submit Submit and Print

* indicates a required field