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HEB Lease Application

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					                                               HEB Properties
                                           APPLICATION FOR LEASE

                                       PLEASE FILL OUT AND RETURN TO
                                             HEB Grocery Company, LP
                                        Attn: Shopping Center Development
                                                 P.O. Box 839955
                                            San Antonio, TX 78283-3955

SECTION A - Backround
Personal Information

Shopping Center or Property you are interested in:

                                                              Social Security Number
Full Name:                                                    (please provide photo copy):


Home Phone:                                                   Date of Birth:


Cell Phone:                                                   Business Phone:

Drivers License # (please provide
photo copy):                                                  Email:


Education                Name                 Level Completed                  Degree Type
High School                                   Some      Graduated
College                                       Some      Graduated
Graduate School                               Some      Graduated


Company Information

Company Name:                                                 Prospective Store Name:

Entity's Legal Name:

Entity's Legal Status:   Corporation          LLC             Partnership                    Sole Proprietor

Prospective Store Name:                                       Dunn & Bradstreet #:


Federal Tax ID#:                                              How long have you been in business:

Describe the type of business you will run? (Provide current business plan (see Section B) include
financial projections of sales and expenses.




Credit History

Your bank's name:                                             Phone #:
City:                                                         State:

Account # :                                                   Account Type:
Account # :                                                   Account Type:
Account # :                                                   Account Type:

Please Circle "YES" or "NO" for the questions below:
1. Have you, your spouse or any occupant listed above ever been evicted or asked to move?                      YES   NO
2. Broken a rental agreement or lease?                                                                         YES   NO
3. Declared Bankcruptcy?                                                                                       YES   NO
4. Been sued for nonpayment of rent?                                                                           YES   NO
5. If need be, will you sign a personal guarantee for your lease?                                              YES   NO
7. Do you, your spouse or any occupant listed above have any current liens or judgments against you?           YES   NO
6. Please provide an explanation for each incident, including state, date, and location:


                                            Section A - Background
                                                     Page 1
Section B - Business Plan

Do you have a current business plan to submit?                   YES          NO
(If NO, please continue to fill out out Section B)

Is your business:          Starting Up            Expanding               Relocating               Other

Current Business Name                                                                   Phone #:

Address:                                                                               State:

Length of time at present location:                                                     Zipcode:

Name of Landlord/Owner:                                                                Phone #:

May we contact them?       YES ____ NO ____

                          box:
Please check appropriate Individual/Sole Proprietor                       Tax ID #:
                         Corporation                                      Tax ID #:
                         Partnership                                      Tax ID #:
                         Other                                            Tax ID #:


Describe the daily operations of the business in detail



Describe your role(s) in the business



If you have other businesses, in addition to this one, please provide pertinent information
for the last twenty-four (24) months, where applicable.



Will you have a continuing role in these businesses? If so, what will that role be?



How do you plan to operate your new business? Who will manage the business?
How many employees will you need?



If your business is a corporation, partnership, or joint venture please describe its legal
and financial structure.



What improvements or changes do you uplan to make to the premises (fixtures, flooring, etc.)
and at what cost? How will improvements and changes be financed?




Describe your anticipated start-up operating expenses at the new location and list amounts
(Include inventory, supplies, initial payroll costs, insurance, etc.)

 Expenses                                Cost                 Expenses                             Cost




Please provide financial revenue and expense projections for the first five years.

How will you finance your start-up business?



Have you hired an architect or general contractor? If so, please list their company names

                                                Section B - Business Plan
                                                          Page 2
Section B - Business Plan
         Page 2
Section C
References

Please complete the attached financial statement. Please provide copies of the past three income tax
returns. Include a means of verification of all items on the attached financial statement, such as account
number, tax bills, tax returns, inventories, etc.


Credit References

Suppliers (Include Name, Address and Phone Number)

Name                                   Address                                  Phone Number




Financial References
Banks, Savings and Loan, and Mortgage companies

Name:
Account#:
Bank
Address:
Phone Number:

Name:
Account#:
Bank
Address:
Phone Number:

Name:
Account#:
Bank
Address:
Phone Number:




Landlord References

Name:
Address:
Phone Number:
Lease Address:
Monthly Rent:                                                 # of Years at Location:


Name:
Address:
Phone Number:
Lease Address:
Monthly Rent:                                                 # of Years at Location:




                                            Section C - References
                                                     Page 3
Section D - Personal Financial Information
      Do you have a balance sheet (depicting net worth) and income
      statement to submit?                                                            YES   NO
      (If NO, please continue to fill out out Section C below)


      Balance Sheet
      Name (Business or Individual):
      Tax ID:

      Assets
      CASH ON HAND & IN BANKS (SCHEDULE 1)
      US GOVERNMENT SECURITIES
      ACCTS., LOANS & NOTES REC.(SCHEDULE 2)
      CASH VALUE LIFE INSURANCE
      OTHER STOCKS & BONDS (SCHEDULE 4)
      REAL ESTATE (SCHEDULE 5)
      AUTOMOBILES (SCHEDULE 6)
      OTHER ASSETS - ITEMIZED




      Total Assets

      Liabilities
      Debts owed
         -REAL ESTATE (PRINCIPLE BAL SCHEDULE 5)
         -AUTOMOBILES (PRINCIPLE BAL SCHEDULE 6)
         -UNSECURED (SCHEDULE 7)
      RENTS & INTREST DUE
      TAXES DUE (SCHEDULE 5)
      LIENS ON REAL ESTATE
      OTHER LIABILITIES (ITEMIZE)




      Total Liabilities

      Net Worth (Total Assets minus Total Liabilities)                          #VALUE!




                                                     Section D- Fiancial Statements
                                                                 Page 4
Balance Sheet
Name (Business or Individual):
Tax ID:


Source of Income                                                  Monthly Income       Annual Income
Salary                                                                  $0                  $0
Bonus &/or Commission                                                   $0                  $0
Dividends & Interest Income                                             $0                  $0
Real Estate Income                                                      $0                  $0

Total Income                                                             $0               #VALUE!

Living Expenses                                                  Monthly Expenses     Annual Expenses
Rent or Mortgage Payment                                                $0                   $0
Food                                                                    $0                   $0
Utilities                                                               $0                   $0
Credit Card Payments                                                    $0                   $0
Automobile Payments                                                     $0                   $0
Loan Payments                                                           $0                   $0
Other Payments                                                          $0                   $0

Total Expenses                                                           $0                 $0

Net Income (Total Income minus Total Expenses)                           $0               #VALUE!

Contigent Liabilities                                            Monthly Expenses     Annual Expenses
Endosor or Co-Signer                                                                         $0
Legal Claims                                                                                 $0
Federal Income Tax                                                                           $0
Other Special Debt                                                                           $0

Total Contigent Liabilities                                              $0                 $0


Insurance Coverage
Please Circle "YES" or "NO" for the questions below:
1. Do you have fire and extended insurance for your home and household goods?       YES             NO
2. Do you have fire and extended insurance coverage for your automobile(s)?         YES             NO
3. Do you have liability insurance for your automobile(s)?                          YES             NO
4. Do you have personal liability insurance                                         YES             NO
5. Do you have other insurance policies not specified above?                        YES             NO
6. Please provide additional insurance information:




                                              Section D- Fiancial Statements
                                                          Page 4
      Schedules:
      Bank Accounts (schedule 1)
      Name & Location                                                       Type of Acct.                Amt. On Deposit




      Total Bank Account Balances                                                                                          $0.00

      Accounts, Loans, & Notes RECEIVABLE (schedule 2)
                                                                      Description     Principle     Monthly
      Name & Address of Debtor                                         of Debt        Balance       Payment         Due Date




      Total Accounts RECEIVABLE                                                             $0.00       $0.00

      Stocks & Bonds (schedule 4)
                                                                                      Mkt
      Name of Stock Shares or Bonds                                   # of Shares Value/Share Total Value Income/Dividends
                                                                                                    $0.00             $0.00
                                                                                                    $0.00             $0.00
                                                                                                    $0.00             $0.00
      Total Stocks & Bonds                                                                          $0.00             $0.00

      Real Estate (schedule 5)
      Address/Description (please provide proof of ownership -         Purchase       Market
      current property tax receipt)                                      Price        Value         Debt Owed Monthly Payment



      Total Real Estate                                                     $0.00           $0.00       $0.00              $0.00

      Automobiles (schedule 6)                                       Purchase                         Debt
      Make & Model (Yr)                                              Price          Mkt Value        Owned      Monthly Payment



      Total Automobiles                                                     $0.00           $0.00       $0.00              $0.00

      Accounts, Loans, & Notes PAYABLE (schedule 7)                   Description     Principle     Monthly
      Name & Address of Debtor                                         of Debt        Balance       Payment         Due Date




      Total Accounts PAYABLE                                                                $0.00       $0.00




I,______________________________, certify that the information listed on this Personal Financial
Statement is true and correct as of this the ______ day of _______________, 20_____.

Signed:_____________________________________________                 Date:_______________________




                                                      Section D- Fiancial Statements
                                                                  Page 4
THIS FORM DOES NOT OBLIGATE EITHER PARTY TO THE PERFORMANCE OF A CONTRACT FOR
LEASEHOLDER PROPERTY. IT IS PURELY FOR INFORMATION AND DOES NOT CONSTITUTE AN OFFER
TO LEASE OR ANY NEGOTIATION FOR SUCH A PURPOSE. BY SIGNING THIS APPLICATION OF LEASE,
THE UNDERSIGNED(S) REPRESENTS AND WARRANTS THAT THE INFORMATION PROVIDED IS TRUE
AND COMPLETE, AND THAT HEB GROCERY COMPANY, LP IS AUTHORIZED TO MAKE ALL INQUIRIES
DEEMED NECESSARY TO VERIFY THE ACCURACY OF THE STATEMENTS HEREIN, INCLUDING
PERFORMING A CREDIT CHECK, AND TO DETERMINE THE APPLICANT(S) CREDITWORTHINESS.




SIGNATURE OF APPLICATION:                       DATE:



APPROVED BY:                                    DATE:




                                     Disclaimer
                                       Page 4

				
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