Personal Information

• First Name
• Last Name
• Street Address 1
• Street Address 2
• City
• State
• Zip
• Email
• Cell Phone
• Company Name
• Work Phone

Name of Business

• Proposed Merchandise Concept (be specific)
• How long in this business?
• Have you leased space in a mall? If so, where? And how long?
• Start Date
• Length of lease desired
• Type of Lease
• • Kiosk
  • In-line Leasing
  • Retail Merchandising Unit (RMU)

What sales volume would you project for your concept?

• Monthly Projected Sales
• Yearly Projected Sales

• What is five plus one?