NEW MEMBER APPLICATION Contact Info:Name* First Last Phone*Email* Home Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Business Details:Company Name Website What does your business do?*Desired date of occupancy?* DD dot MM dot YYYY Last Year's Revenues: Pre-revenue $1 - $99,999 $100,000 - $249,999 $250,000 - $999,999 $1,000,000+ Have you ever willfully and intentionally refused to make payments when due?* Yes No Do you know of anything which may effect your ability to pay your monthly investment?* Yes No Have you ever been convicted of any crime?* Yes No Have you ever been evicted from any tenancy?* Yes No Have you ever filed a petition for bankruptcy?* Yes No If so, when?* Is there any additional information about yourself or your business that you would like to share?Terms & ConditionsI hereby certify that the answers I have given in this application are true and correct to the best of my knowledge. I understand that any false answers or statements made by me will be sufficient grounds for termination of my membership.* I have read and agree to the Terms and Conditions
