Rental Order Form
Renter's Information
Renter's Full Name
*
First Name
Last Name
Renter's Phone Number
*
-
Area Code
Phone Number
Renter's E-mail
*
Renter's Date of Birth
*
-
Month
-
Day
Year
Date
Drivers License #
*
Drivers License Expiration Date
*
-
Month
-
Day
Year
Date
Co-Renter's Application (If Applicable)
Full Name
First Name
Last Name
Phone Number
-
Area Code
Phone Number
E-mail
example@example.com
Date of Birth
Please select a month
January
February
March
April
May
June
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Month
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1
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31
Day
Please select a year
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1982
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1933
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1925
1924
1923
1922
1921
1920
Year
Drivers License #
Drivers License Expiration Date
-
Month
-
Day
Year
Date
Residence Information
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Rent or Own
*
Rent
Own
Mailing Address (if different)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Utilities in whose name
*
Move in Date
*
-
Month
-
Day
Year
Date Picker Icon
Move Out Date
*
-
Month
-
Day
Year
Date Picker Icon
Landlord/Mortgage Company
*
Contact
*
Phone Number
*
-
Area Code
Phone Number
Lease in Whose Name
*
Length of Lease
*
Month Payment
*
Amount Paid Monthly
*
Previous Address
Previous Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Move in Date
*
-
Month
-
Day
Year
Date Picker Icon
Move Out Date
*
-
Month
-
Day
Year
Date Picker Icon
Amount Paid Monthly
*
Landlord or Company Name
*
Landlord Phone #
*
-
Area Code
Phone Number
Landlord Email
*
(if available)
Reason for Leaving
*
Please Select
End of Lease
Eviction
Bad Living Conditions
Work / Education Related
Other
If "other" please explain:
*
Vehicle Make/Model
*
Vehicle Color
*
License Plate #
*
State
*
Financed By
*
Renter's Home Phone
*
-
Area Code
Phone Number
Phone In Whose Name
*
Renter's Cell
*
-
Area Code
Phone Number
Co-Renter's Cell
*
-
Area Code
Phone Number
Renter's Email
*
example@example.com
Co-Renter's Email
*
example@example.com
Renter's Income
Current or Most Recent Employer
*
Position
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Supervisor Name
*
First Name
Last Name
Supervisor Phone #
*
-
Area Code
Phone Number
Hire Date
*
-
Month
-
Day
Year
Date
Shift
*
Department
*
Paid
*
Weekly
Bi-Weekly
Semi-Monthly
Monthly
Day Paid
*
Take Home
*
Co-Renter Income
Current or Most Recent Employer
Position
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Supervisor Name
First Name
Last Name
Supervisor Phone #
-
Area Code
Phone Number
Hire Date
-
Month
-
Day
Year
Date
Shift
Department
Paid
Weekly
Bi-Weekly
Semi-Monthly
Monthly
Day Paid
Take Home
Personal References
Reference #1 Full Name
*
First Name
Last Name
Relationship to Applicant
*
Phone Number
*
-
Area Code
Phone Number
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Reference #2 Full Name
*
First Name
Last Name
Relationship to Applicant
*
Phone Number
*
-
Area Code
Phone Number
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Reference #3 Full Name
First Name
Last Name
Relationship to Applicant
Phone Number
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Reference #4 Full Name
First Name
Last Name
Relationship to Applicant
Phone Number
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Other Information
Have you rented from another RTO company before? If so, which company?
What year?
How did you hear about us?
Door Hanger
Radio
Mailer
Word-of-Mouth
Website
Google
Social Media
What is the best day to make your rental payment?
Final Submit
RELEASE OF INFORMATION TO CHOICE RENTALS: PLEASE READ BEFORE SIGNING
THE INFORMATION I HAVE PROVIDED ON THIS RENTAL ORDER IS CORRECT AND I AUTHORIZE CHOICE RENTALS TO CONFIRM ALL INFORMATION I HAVE PROVIDED. CHOICE RENTALS MAY CONTACT ANY PERSON OR COMPANY I HAVE LISTED ABOVE AND I FULLY RELEASE ALL PARTIES FROM ALL LIABILITY FOR ANY DAMAGE THAT MAY RESULT. MY (OUR) SIGNATURE(S) BELOW INDICATES THAT FOR THE PURPOSES OF CONFIRMATION, I (WE) HAVE VOLUNTARILY WAIVED THE PROTECTION OF ALL PRIVACY LAWS. THIS FORM IS AN APPLICATION TO RENT AND MAY BE REJECTED IF I (WE) FAIL TO QUALIFY OR IF ANY OF THE INFORMATION PROVIDED IS FOUND TO BE FALSE. BY SIGNING BELOW, I (WE) AGREE TO RECEIVE ELECTRONIC MARKETING MATERIALS FROM CHOICE RENTALS RENT-TO-OWN.
*
I Agree
Applicant Signature
*
Date
*
-
Month
-
Day
Year
Date
Co-applicant Signature
Date
-
Month
-
Day
Year
Date
Submit Application
Submit Application
Should be Empty: