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Site Lease Application
Submit two (2) copies of application and all attachments
Agreement Holder Information:
Name of Agreement Holder: Phone No:
Tax Payer ID No. (if none Social Security No.) Contact Name & Phone No:
Corporation (if any): State in which incorporated:
Complete Business Address (if different from below):
Complete Billing Address & Phone Number:
If not a corporation, name(s) of owners or partners:
Location Information (attach copy of Railroad right of way map with area requested outlined):
Name of the nearest city or town: County: State:
Distance and direction from nearest Railroad milepost:
Quarter Section, Section, Township, Range:
What will site be used for
Will use of the site involve use of any hazardous materials Yes No
If yes, please list materials:
What buildings or structures are currently on site
Will any buildings or structures be placed on site Yes No
If yes, list buildings/structures to be placed on site, include the estimated cost and attach 2 sets of complete site plans.
party financing be involved Yes No
If yes, please include a letter from the financial institution giving the term of the loan you are requesting.
Do you have any other property at/near this location under lease Yes No
If yes, Agreement No.(s):
Do you own the land adjoining the area you are interested in leasing Yes No
Do you need access across railroad tracks Yes No
If yes, have you received written permission from Railroad for access across its tracks Yes
If yes, Agreement No.(s):
For construction on site the following must be included with the application:
•a photograph of the site
•2 (two) sets of site plans
•A copy of your business plan
Failure to provide all of the requested information will result in the automatic cancellation of this application.
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