Rental Application

Rental Order Form

Renter's Information
Renter's Full Name*

First NameLast Name
Renter's Phone Number*

Area CodePhone Number
Renter's E-mail*
Renter's Date of Birth*

MonthDayYear
Date
Drivers License #*
Drivers License Expiration Date*

MonthDayYear
Date

Co-Renter's Application (If Applicable)
Full Name

First NameLast Name
Phone Number

Area CodePhone Number
E-mail
example@example.com
Date of Birth

MonthDayYear
Drivers License #
Drivers License Expiration Date

MonthDayYear
Date

Residence Information
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Rent or Own*

RentOwn
Mailing Address (if different)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Utilities in whose name*
Move in Date*

MonthDayYear
Move Out Date*

MonthDayYear
Landlord/Mortgage Company*
Contact*
Phone Number*

Area CodePhone Number
Lease in Whose Name*
Length of Lease*
Month Payment*
Amount Paid Monthly*
Previous Address
Previous Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Move in Date*

MonthDayYear
Move Out Date*

MonthDayYear
Amount Paid Monthly*
Landlord or Company Name*
Landlord Phone #*

Area CodePhone Number
Landlord Email*
(if available)
Reason for Leaving*
If "other" please explain:*
Vehicle Make/Model*
Vehicle Color*
License Plate #*
State*
Financed By*
Renter's Home Phone*

Area CodePhone Number
Phone In Whose Name*
Renter's Cell*

Area CodePhone Number
Co-Renter's Cell*

Area CodePhone 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

CityState / Province

Postal / Zip Code
Supervisor Name*

First NameLast Name
Supervisor Phone #*

Area CodePhone Number
Hire Date*

MonthDayYear
Date
Shift*
Department*
Paid*

WeeklyBi-WeeklySemi-MonthlyMonthly
Day Paid*
Take Home*

Co-Renter Income
Current or Most Recent Employer
Position
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Supervisor Name

First NameLast Name
Supervisor Phone #

Area CodePhone Number
Hire Date

MonthDayYear
Date
Shift
Department
Paid

WeeklyBi-WeeklySemi-MonthlyMonthly
Day Paid
Take Home

Personal References
Reference #1 Full Name*

First NameLast Name
Relationship to Applicant*
Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Reference #2 Full Name*

First NameLast Name
Relationship to Applicant*
Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Reference #3 Full Name

First NameLast Name
Relationship to Applicant
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Reference #4 Full Name

First NameLast Name
Relationship to Applicant
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / 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 HangerRadioMailerWord-of-MouthWebsiteGoogleSocial 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*

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Date*

MonthDayYear
Date
Co-applicant Signature

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Date

MonthDayYear
Date
Should be Empty: