Application - Scioto

I. Company Information
Business Name*
Trade Name (if different)
Address
Street Address Address Line 2 City State ZIP Code
Main Phone Number
Website
Legal Entity (select one)
- For Profit corporation
- Limited Liability Company
- Non Profit Corporation
- Other
Primary Contact Name
First Last
Primary Contact Phone*
Number of Locations
Primary Contact Email
Enter Email Confirm Email

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III. Financial Information (Provide all of the following)
1. Provide the last three (3) years (audited if available), including: A. Income Statements B. Balance Sheets C. Cash Flow Statement 2. Year-to-date Financial Statements 3. Business Tax filings for the last two (2) years
File
Max. file size: 50 MB.
IV. Growth Plans
Type of Property
- Residential
- Commercial
Home Price Range Estimate
Expected Annual Number of Homes Needed Over Next 2 Years
V. Ownership: List Primary Owner
1. Provide the last three (3) years, audited if available, including: 2. Provide interim financial statement for current year to date
Name
First Last
VI. Corporate
Insurance: Valid insurance documentation will be requested on approval. Key Officers: Provide Bio of Key Officers of the organization. Organization Chart: If there are multiple entities.
CERTIFICATION AND CONSENT
I certify, to the best of my knowledge, the information contained in this Provider Application is true, complete and correct as of the date set forth below. Furthermore, I hereby authorize and consent to Scioto Properties verifying the information contained in this Provider Application and obtaining a credit report on the business.
Name*
First Last
Title*
Date*
MM slash DD slash YYYY
CAPTCHA
Name
This field is for validation purposes and should be left unchanged.

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I. Company Information