COVID-19 Tenant Relief

Important!

Instructions: Please fill-out this request form in full and submit it with any necessary attachments.

To complete this form you will need the following:
- Basic Lease Information
- 2019 Financial Statements (Income Statement, Balance Sheet, and Statement of Cash Flows - Parent Company)
- Month-end financial statements (P&L), January 2020 - Current 2020.
- Any stimulus-related denial letter(s) issued to Tenant

Section 1

Name of individual filling out this form *

First

Last

Date / Time *

Date

Time

Tenant's Name (Signing entity or person(s) on the lease) *

Contact Name *

First

Last

Contact Phone Number *

Contact Email *

Email

Confirm Email

Tenant's Leased Property Address *

Address Line 1

Address Line 2

City

State

Zip Code

Is the Tenant a subsidiary entity? *

Yes
No

Section 2

Have you or your ownership group been Denied any of these loam programs? *

No
Yes
Unsure, It is still being processed

Please describe the relief or proposal your or your entity is requesting from the property owner. *

Section 3

Other information required in addition to the Tenant Relief Intake Form to process Tenant's Relief Request

Please upload the following documents:

2019 Financial Statements (Income Statement, Balance Sheet and Statement of Cash Flows - Parent Company) *

Click or drag a file to this area to upload.

Month-end financial statements (P&Ls), January 2020 - Current 2020. *

Click or drag a file to this area to upload.

Any stimulus-related denial letter(s) issued to Tenant

Click or drag a file to this area to upload.

Financial Relief Request and Statement of Accuracy

As of the date listed above, and due to the on-going financial hardship attributed to the COVID-19 outbreak, the Tenant is requesting financial relief or assistance in some form from Landlord. This request is not an agreement, amendment to an existing constitute a tenant default. This information is being provided for discussion purposes only at this time.

Landlord will expeditiously work to review completed Tenant Relief Requests. Priority review will be provided to fully complete submissions, which may include the submission of any and all documents listed in Section III of the Tenant Relief - Intake Form. Further documentation may be requested by Landlord in conjunction with processing this request.

Do you agree to the following statement of accuracy? *

Yes
No

Tenant acknowledges that the information provided with this request including financial statements and documents that may be submitted as attachments in conjunction with this request, are true and accurate to the best of Tenant's knowledge. If Tenant becomes aware that previously submitted documents or financial statements being used to evaluate the Tenant's circumstances are incorrect, Tenant will immediately notify Landlord (within 24 hours and prior to the signing of any and all agreements being contemplated by Tenant and Landlord) of the inaccuracy or inaccuracies and expeditiously work to correct them. Knowingly submitting inaccurate financial statements for financial gain is an act of fraud.

Signature *

First

Last

By typing my name in the above box and submitting this form I agree that I am a authorized Signatory of the Tenant entity and have reviewed the Tenant Relief Request Form, the Financial Relief Request and Statement of Accuracy, and have reviewed the attachments listed above and, to the best of my knowledge, represent the information provided as accurate as of the date of this document.