AFFILIATE APPLICATION
Except to the extent necessary to process this application, otherwise described below, or required by law, we will keep your financial and personal information confidential. We will not contact your current employer without your consent.

 Instructions:

·           Complete and return this application in connection with your interest in being approved to become a MerrickDamon Real Estate affiliate

·           Complete this application using a typewriter or print neatly (it will be scanned electronically)

·           Each person or entity that would have an interest in the affiliate must submit an application (a married couple may complete a single form)

·           Documents listed on page 8 must be submitted as part of this application
 

Personal Information

Contact Information

If Yes then your spouse must apply with you to become a affiliate, and your spouse must provide the information for Co-Applicant.

Have you ever been convicted of a crime, other than a minor traffic violation?

YOUR INTEREST IN BECOMING A MERRICKDAMON REAL ESTATE AFFILIATE

GEOGRAPHIC INTEREST

EDUCATION

Applicant

Co-Applicant

BUSINESS EXPERIENCE

Applicant

Co-Applicant

Applicant

Co-Applicant

OWNERSHIP OF AFFILIATE AND MANAGEMENT OF MERRICKDAMON REAL ESTATE

INVESTMENT FINANCING**

List the sources of capital that you plan to use to cover the portion of the Investment above that you plan to pay in cash (e.g. savings account, stocks, etc.)

List the sources of capital that you plan to use to cover the portion of the Investment above that you plan to pay in cash (e.g. savings account, stocks, etc.)

PERSONAL FINANCIAL STATEMENT

 

As of Application Date

Applicant

Co-Applicant

Applicant

Co-Applicant

PRESENT ANNUAL INCOME

Applicant

Co-Applicant

Applicant

Co-Applicant

SCHEDULES TO PERSONAL FINANCIAL STATEMENT (Attach additional sheets if necessary)
Schedule 1 Asset Accounts and Individually Held Securities

Schedule 2 Real Estate

Schedule 3 Loans Payable (not secured by real estate)

Please note, the follow documents must be submitted with this application to be considered completed.MerrickDamon Real Estate may request additional documentation and information before rendering a decision on this application.

▪       Last 2 months statement for each account listed in Schedule 1 (obtain an updated statement from your financial institution if the one you have is more than 90 days old);

▪       Property tax statement for each property listed in Schedule 2;

▪       If any required document cannot be provided, then a written explanation of the reasons why that required document is not available.

 
By signing below:

▪       I am representing and warranting that the information in this application (including information in the documents that I submit as part of my application) is true and correct.

 

▪       I understand that MerrickDamon Real Estate will rely on this information when determining whether to approve my application. MerrickDamon Real Estate approves my application, and later determines that the information I provided was materially false or incomplete, then MerrickDamon Real Estate will have a right to terminate the affiliate that I acquire, which among other things required that I be of good character.

 

▪       I hereby authorize MerrickDamon Real Estate (and its affiliates and authorized agents) to make any additional credit, background, and character checks that MerrickDamon Real Estate or its affiliates deem appropriate, including obtaining of a person credit report. If my application is approved, then this authorization shall continue as long as I am in the process of developing a MerrickDamon Real Estate, or I remain a MerrickDamon Real Estate affiliate, or I have any obligations to MerrickDamon Real Estate or its affiliates, and any information obtained may be used by MerrickDamon Real Estate and its affiliates in an attempt to enforce my obligations to MerrickDamon Real Estate or its affiliates.

 

▪       I hereby authorize all persons, schools, banks and financial institutions, past or present employers, credit bureaus, and law enforcement agencies to release to MerrickDamon Real Estate (and its affiliates and authorized agents) any information about me that they possess, without qualification or restriction, and I hereby release them from any liability for complying with this authorization. I authorize that a photocopy or facsimile or this release be considered as valid as the original.

 

▪       I am warranting and representing that I do not currently have any interest in a Real Estate business that would result in a violation of the covenants against competition contained in the affiliate agreement governing the business I am seeking to acquire.

 

▪       I understand that if my application is approved, and I acquire a MerrickDamon Real Estate affiliate, then MerrickDamon Real Estate and its affiliates may, but shall have no obligation to, from time to time extend credit to me in connection with my operation of a MerrickDamon Real Estate, including but not limited to my purchases of MerrickDamon Real Estate brand products.

 

 
                                                                   

 

 

 

Except to the extent necessary to process this application, otherwise described below, or required by law, we and our affiliates will keep your financial and personal information confidential. We will not contact your current employer without your consent