Application

Basic Information

Income & Housing

References

Finalize

Customer Information

Follow the steps below to complete your Customer Information Form.

Basic Information

Location*

First Name*

Last Name*

Email Address*

Cell Phone*

Address*

City*

State*

Zip Code*

Income and Housing

Employer*

Employer Phone*

Employer State*

Job Title*

Length of Employment*

Monthly Income*

Pay Day*

Pay Period*

Monthly Rental Payment Amount*

Landlord Name*

Landlord Phone*

Time Lived at Residence*

References

Reference 1 - Family

Full Name*

City*

State*

Relationship*

Phone*

Reference 2 - Family

Full Name*

City*

State*

Relationship*

Phone*

Reference 3 - Family or Friend

Full Name*

City*

State*

Relationship*

Phone*

Reference 4 - Family or Friend

Full Name*

City*

State*

Relationship*

Phone*

Please read this statement before signing

I promise that the information I have provided on this form is correct. I authorize complete verification of all information I have provided. You may contact any person or company listed above and I fully release all parties from liability for any damage that may result. My (our) signature(s) indicates that for purposes of verification, I (we) have voluntarily waived the protection of all rights to privacy laws. This order may be rejected if any information provided is found to be false. By providing your contact information, you consent to receive emails from Rent One which may include emails related to payments or advertisements, receive texts from Rent One which may include texts related to payments or advertisements, and receive telephone calls from Rent One that may include prerecorded messages on behalf of Rent One related to payments or advertisements.

RELEASE OF INFORMATION TO RENT ONE

By your signature below, whether one or more applicants, you also agree to allow Rent One employees to contact the references listed above and your employer(s) to verify your information and to assist Rent One in its collection efforts if you fail to renew the rental agreement or return the merchandise to Rent One on time. This waiver is valid until you revoke it by notifying Rent One in writing by certified mail. I have read and understand these statements.

This Electronic Signature Consent (“Consent”) sets forth the terms of my consent to sign documents electronically through the Rent One Signature System (“System”).

I may decline to electronically sign any document. I may contact Rent One and request a paper copy of any document signed electronically through the System.

I understand that (i) electronically signing any documents(s) legally binds me in the same manner as if I had signed in a non-electronic form, and (ii) the electronically stored copy of my signature, is considered to be the accurate and complete record, legally enforceable in any proceedings to the same extent as if such documents were originally generated in printed form. I agree not to contest the admissibility or enforceability of Rent One's electronically stored copy of this Consent and any other documents. By using the System to electronically sign and submit any document, I agree to the terms and conditions of this Consent.

Renter Signature*

Today's Date

NOTE: All applications must be verified by store manager before rental application can be approved.

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