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Individual Lease Application

* Indicates required information. For questions or concerns about this form please read our Privacy Policy.

For additional guarantors, please complete a second application.

Primary Applicant Information
First Name *
Last Name *
Street Address *
City *
State *
Zip *
Home Phone *
Fax
E-mail Address *
Confirm E-mail Address *
Date of Birth * (mm/dd/yyyy)
Social Security Number *
Citizenship *
Own or Rent? *
How Long? * years
Mortgage Holder or Landlord *
Monthly Mortgage-Rent Payment? *
Personal Bank *
Previous Address
(if less than 2 years)
City
State
Zip



Current Employment
Employer*
Street Address *
City *
State *
Zip *
Employer Phone *
Employer Fax
Years Employed*
Position *
Verfiable Annual Salary *
Additional Income
Source



Previous Employment (if less than 2 years)
Previous Employer
Street Address
City
State
Zip
Phone



Vehicle
  Please Enter the Description of the Vehicle you are interested in leasing:
Year *
Make *
Model *
Body Style
Color
New or Used
Mileage
Selling Price *
Down Payment
Finance Amount
Term of Lease
 
The above information is correct to the best of my knowledge. Premier Financial Services,
LLC (PFS) will rely on this application in deciding whether to grant the requested credit and
may keep this application on file. I authorize PFS, and its affiliates, to review my credit and
employment history, and, if approved, obtain future credit reports as necessary. PFS will
safeguard my information and will use it for internal purposes only. I understand that federal
law requires financial institutions to obtain, verify, and record identifying information.
  Indicate that you understand and agree with the above statement by typing your name below:
I understand and agree: *
Comments:
How to Submit Submit Form to Premier Financial Services
Create a Printable Version For Faxing (203-267-7773)
 
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