YorkPremierApp

Full Name *

Full Name

Phone *

Phone

Email *

Date of Birth *

DOB

Social Security Number *

ID or Driver's License *

Skip to "Address" if you do not have a Co-Applicant

Co-Applicant Full Name

Co-Applicant Phone Number

Co-Applicant Date Of Birth

Co-Applicant Social Security Number

Co- Applicant ID or Driver's License

Address

Address

Street Address *

City *

State *

Postal Code *

Residence Is *

Current Landlord - If Renting

Landlord Phone Number

How Long Have You Lived Here? *

Employment Information

Current Employer/Source of Income *

Employer Phone Number

Pay Frequency (Weekly, Biweekly, Semi-Monthly, Monthly)

Skip To "References" If No Co-Applicant

Current Employer Co-Applicant

Co-Applicant Employer Phone Number

Co-Applicant Pay Frequency (Weekly, Biweekly, Semi-Monthly, Monthly)

References - Family Members Preferred (2 Minimum)

Reference #1

Full Name Ref #1 *

Phone Number Ref #1 *

Full Address Ref #1

Relationship Ref #1 *

Reference #2

Full Name Ref #2 *

Phone Number Ref #2 *

Full Address Ref #2

Relationship Ref #2 *

Reference #3

Full Name Ref #3 *

Phone Number Ref #3 *

Full Address Ref #3

Relationship Ref #3 *

Reference #4

Full Name Ref #4

Phone Number Ref #4

Full Address Ref #4

Relationship Ref #4

Disclosure For Order

RELEASE OF INFORMATION TO PREMIER

Please Read Statement Before Signing

You agree to allow us or our agents and assigns, including debt collectors, to contact you for business purposes including application qualification notification, solicitation, marketing and collections via multiple communication channels including, email, telephone, or text message, directly or by using a dialer, automatic telephone dialing system, interactive voice recognition system or artificial or prerecorded voice or message at any number you have given us or any number you give us in the future (whether home, cell or mobile service) even if you are charged for the call by your telephone service provider. You expressly agree to be contacted via such automated calls and communication methods. You do not have to agree to get marketing communications from us in order to rent products from us. You can opt out of getting marketing messages from us by notifying us of your intent to opt out.

Applicant - Signature (Please type in full name) *

Co-Applicant Signature (Please type in full name)

Purchase Information

What Item Are You Interested In Renting?

How Did You Hear About Us?