Primary Lot

Secondary Lot (Complete If Applicable)

Mailing Address (Complete If Applicable)

Owner / Officer 1

Owner / Officer 2

Owner / Officer 3

Onsite Manager (Complete if Absentee Owner)

Additional Information

Current Funding

Non Disclosure / Confidentiality Agreement

By filling out the below section, I / We understand and agree that all
information provided by Partners Capital Finance, LLC is confidential and will not be shared with anyone other
than the owners / partners / officers and their legal council.