Premier Communities Management Company
2711 N. Haskell, Ste 2650
Dallas, TX 75204. 

In addition to completing this form, the following information is needed:
       ●  Certificate of Insurance – must come directly from agent
       ●  Commercial Liability minimum $1 million and Worker’s Compensation - must come directly from insurance agent
       ●  (Premier Communities must be named as Certificate Holder on Certificate.)
       ●  Completed W9

	Enter your contact information:
*	Company Name:
*	Your Name:
*	Your Title or Position:
*	Business Phone:
*	Cell Phone:
*	Fax Number:
	Email Address:
	Information about the company:
*	Location Address:
*	City, State, Zip:
*	Tax ID Number:
	If Location Address is a P.O. Box, an additional physical address of the company owner is needed.
	Additional Physical Address:
	Additional City, State, Zip:
*	Name of Principal Owner(s):
*	Number of Years in Business:
	Type of Company:
	Mailing Address (if different from location address)
	Mailing Address:
	City, State, Zip:
	Please describe the type of work you are applying for:
*	Type of Service:
	Description of Services:
	References (please include phone number or email address):
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