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

A security deposit of $200.00 is required before move-in date and will be refunded to the Applicant if there is no outstanding balance remaining for any reason regarding the rented apartment. Deposit will be forfeited if apartment lease/obligations are not fulfilled by Applicant. Any forfeiture of deposit does not credit towards any balance owed. Applicant understands that by signing below they agree to be responsible for all collection fees in
the event of any default. Applicant understands that this deposit will hold the requested apartment and that the amount will be forfeited if Applicant decides not to take the apartment and fails to give cancellation notice within 72 hours of submitting this application. Upon vacating, a minimum charge of $100.00 will be deducted from deposit for housekeeping/redecorating fees.* INITIALS

I agree to provide Premier Living Services, Inc. a two week (14 day) written notice before vacating the rented apartment * INITIALS

There is a $25.00 application fee that will be refunded if / when the applicant signs and returns the lease agreement within five days of occupancy.
* INITIALS (NOTE: Initialing here does NOT imply you have a pet, only that you understand the pet policy enforced by Premier Living Services, Inc.  ALL pets are to be listed in written form PRIOR to arriving in the apartment.)

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

If the pet is approved by Premier Living Suites, the following pet fees apply: For each pet 24 lbs. or under, there is a $200.00 non-refundable fee. For each pet 25 lbs. or more there is a $300.00 non-refundable fee. (Maximum of 2 pets per apartment). * INITIALS


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
Closest Relative/Secondary Address:
Additional Occupants/Relationship to Tenant:


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) *      3 or 4 digit security code: *      Exp. Date: *
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, I AGREE



Post Office Box 361383 • Birmingham, AL 35236 • Toll Free 800.987-8828 •Office 205.978-8885 • Fax 205.978-8892 • www.premierliving.com