Application for Property Agreement

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JEFFRIES LIMITED LIABILITY COMPANY

377 Fisher Road, Suite H

Grosse Pointe, Michigan 48230

313-882-0899 jeffriesllc@gmail.com 313-600-7678

Jeffries-llc.com

APPLICATION FOR PROPERTY RENTAL

Name:______________________________________________ Date: _______________________________

Address__________________________________________________________________________________________________________

Home Phone:_________________________________________ Cell Phone:_____________________________________________

Email address:_____________________________________________________________________________________________________

1. Property Address: _________________________________________________________________________________________________

2. Terms of Lease.

a. __________ year lease to begin ______________ thru ________________ at a monthly rental rate of $_______________. Additional rents consist of _______% of the electricity monthly, ______% of the gas monthly_________% of the water monthly and prorata share of taxes for the retail space located __________________ Grosse Pointe Michigan

b. Rent will increase____% per year for the term of the lease

c. Two (2) three (3) year renewals

3. Security Deposit Amount $______________

4. Names and contact information of Persons and/or Principals who will be on premises.

______________________________________________________________________________________________________________

5. Make and model of automobile(s) and license plate number(s):

______________________________________________________________________________________________________________

6. References:

a. Former landlord

i. Name_________________________________________________________

ii. Address_______________________________________________________

iii. Phone_________________________________________________________

b. Two other references

i. ____________________________________________________________

________________________________________________________________

ii. ______________________________________________________________

________________________________________________________________

c. Bank_________________________________________________________________

7. I hereby agree to rent the above premises on the above terms and conditions and hereby deposit, by check or cash, the sum of $___________ on account with Landlord (received_________) as a good faith security deposit. Deposit is non-refundable unless the references are not satisfactory or this application is rejected by the landlord. Upon execution of the intended lease with Jeffries LLC, the money will be applied to the Security Deposit.

Dated:______________________

Applicant___________________________________Lessor___________________________________

Edward S. Jeffries, MD

President

Jeffries LLC