Corporate/Company Rental Application

Please Initial each box in this section in acknowledgment:

There is a $85.00 application processing fee that is due in advance to approve client (application can be kept on file for future rentals).* INITIALS

There is a one-time cleaning fee of $150.00 that is due with the first rental invoice.* INITIALS

The applicant understands that the landlord requires a fourteen (14-day) written notice prior to vacating the rental property. * INITIALS

If pet is approved by landlord, pet fee is $300.00 per pet (2-pet maximum with no aggressive breeds allowed). * INITIALS

Pets: * yes no    How many: *      Type/Breed(s): *      Weight(s): *

COMPANY INFORMATION
Company Name:* Company Website:*
Fed. ID# *      Contact Name:
Street Address:
City:       State: select a state Other (non-US) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming      Zip:      Contact Phone:
Company Phone:      Fax:      Email:*
Human Resources Contact:      Phone Number:
Reason for stay: * Temp Need Relocating     Dunn & Bradstreet Number:

RESIDENT INFORMATION
Name:*      Phone:
SSN#*      Date of Birth (mm/dd/year) * mm 123456789101112 / dd 12345678910111213141516171819202122232425262728293031 / yyyy 20132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119201919191819171916191519141913      Mobile Phone:      
Present Street Address:
City:      State: select a state Other (non-US) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming      Zip:
Position:      Email:
Supervisor’s Name:      Supervisor’s phone:
Emergency Contact Information:

PAYMENT INFORMATION

*CREDIT CARD REQUIRED BUT DOES NOT HAVE TO USED AS FORM OF PAYMENT*
Deposit Payment : Cash Check Credit Card Direct Bill
Rent Payment :      Cash Check Credit Card Direct Bill

Name on Card:
Credit Card # (Visa/MC/Discover) *      Exp. Date: *      3 or 4 digit security code: *
Address where you receive the credit card statement: *
City: *      State: * select a state Other (non-US) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming      Zip: *

How did you hear about our service?    Do you need real estate assistance? yes no

By selecting "yes, I agree" below, you acknowledge that the information provided in this application is true and correct to the best of your knowledge. Premier Living Services, Inc. is authorized to make any investigation in your personal, financial and/or credit history through any investigative or credit agencies or bureaus. You also authorize Premier Living Services, Inc. to charge the credit card above.

YES, AGREE *