Specialty Leasing Application First Name*Last Name*Company Name*Street Address*Street Address 2City*State*-- Select --AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingZIP*Email Address*FaxHome Phone*Cell Phone*Work Phone*Commencement Date*End DateI am interested in:*RMUKioskIn-line SpaceWho is your target customer?Gender*MaleFemaleMale/FemaleAge*-- Select --Under 1818-2425-3435-4445-54Over 55Income Level*-- Select --Under $15,000$15,000-$24,999$25,000-$34,999$35,000-$49,999$50,000-$74,999$75,000-$99,999$100,000 or moreProduct / Concept InformationWhat will be your average price point?*What sales volume would you project for your concept?Monthly Sales*Annual Sales*Is your merchandise:*Hand-crafted by yourselfWholesaledFranchisedPlease describe in detail your concept & merchandise:Do you have established resources / suppliers for the product you will sell?*YesNoHow long does it take to receive or produce your product?*Attach image of product or RMUAre you currently operating a business?Are you currently operating a business?*YesNoHow many locations?How many years have you operated this business? Have you operated any other businesses:*YesNoHave you operated a business in any other mall before?LocationDatesTypePermanentTemporarySalesLocationDatesTypePermanentTemporarySalesLocationDatesTypePermanentTemporarySalesLeasing QuestionsProposed Merchandise Concept/themePlease describe in detailWould you like a product image mailed to you?*YesNoEmailThis field is for validation purposes and should be left unchanged.