Requested Rental Location:
Desired Dates of Stay:
(This is an approximation of how long you will be in the apartment. It does NOT serve as the required 14 day written notice to vacate.)
Number of Bedrooms Needed:
Quoted Rent Amount:
$

Individual Rental Application

Please Initial each box in this section in acknowledgment:

There is a $25.00 application / processing fee that is charged ONLY if the applicant cancels or is not approved for any reason.* INITIALS

There is a one-time cleaning fee of $125.00 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): *


APPLICANT INFORMATION

Full Name:*      Date of Birth (mm/dd/year) * / /
SSN# *      Driver’s License Number and State
Present Street Address: *
City:*      State: *      Zip: *      Present home phone:
Cell Phone:      Email: *
Reason for stay: * Temp Need Relocating   Have you ever been convicted of a felony? * yes no    
Have you ever filed bankruptcy? * yes no
Emergency Contact:
Additional Occupants:


EMPLOYMENT / SELF-EMPLOYMENT INFORMATION (Section MUST be completed IN FULL)

Employer:      Business phone:
Business Address:
City:       State:      Zip:       Position:
Salary per month:*$      Supervisor’s Name:      Supervisor’s phone:


PAYMENT INFORMATION

*CREDIT CARD REQUIRED BUT DOES NOT HAVE TO USED AS FORM OF PAYMENT*
Deposit Payment :
Rent Payment :     

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: *      Zip: *

How did you hear about our service?      Do you need Premier Living Mortgage 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



2736 Tyler Rd • Birmingham, AL 35226 • Toll Free 800.987-8828 • Office 205.978-8885 • Fax 205.978-8892 • www.premierliving.com