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Premier Realty Grays Harbor, LLC. Verifies part or all of the information given on this application and
utilizes the data to determine your qualification to lease/rent. This verification may include rental
and/or residence history, any previous eviction(s), civil suits which Applicant was party to, criminal
history, current and/or past employment and credit history (including any bankruptcy, judgments or
collection activity).
Application valid for 90 days
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Address you are inquiring about:_______________________________ Today’s Date:________________
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Applicant:
e-mail address ________________________________
Name- Last:_____________________________________ First:_____________________ MI:_______
Present Address:___________________________ City:________________ State:______ Zip:________
Social Security #:_____________________ Date of Birth:__________________ Phone:_______________
Employer:________________________________ Occupation:_________________ How Long?________
Monthly Income:_________________
Co-Applicant
e-mail address ________________________________
Name-Last:______________________________________ First:_____________________ MI:_________
Social Security #:_____________________ Date of Birth:__________________ Phone:_______________
Employer:________________________________ Occupation:_________________ How Long?________
Monthly Income:_________________
Previous Rental References: Landlord Name & Property Address
Name: ___________________________ Address:_________________________ Phone:_______________
Name: ___________________________ Address:_________________________ Phone:_______________
Name of nearest relative not living with you
Name:____________________________ Relationship:____________________ Phone:_______________
Name of a friend (not related to you)
Name:____________________________ Phone:_____________________
Minimum $200.00 Non-refundable Pet Fee PER PET
Pet(s) Check box: Inside
Outside
Type______________________________________________
Number of People Living in Household: ______________
Names & Ages:__________________________________________________________________________
Have you ever petitioned for bankruptcy?________________ If yes, when?___________________________
Have you ever been evicted from tenancy?_________ If yes, why?___________________________________
I/WE DECLARE THAT THE FOREGOING INFORMATION IS TRUE AND CORRECT. I/WE
AUTHORIZE ITS VERIFICATION, INCLUDING PULLING A CREDIT REPORT (IF APPLICABLE).
Please provide us with a copy of your current WA driver’s license, SSI card and $25 screening fee per Applicant.
I/we agree that Landlord may terminate tenancy immediately if information contained on this application is
false.
_______________________________________
Applicant
_______________________________________
Co-Applicant
Premier Realty Grays Harbor, LLC- Property Management Division
421 West State Street; Aberdeen, WA. 98520 360-533-1906
RENTAL APPLICATION
To Whom it may Concern:
I/we have made rental application with Premier Realty Grays Harbor and hereby request that you
cooperate with them by releasing information regarding our past tenancy with you.
Thank You,
___________________________________
___________________________________
Signature
Signature
___________________________________
___________________________________
Printed Name
Printed Name
_______________________
Date
Updated Mar 2015