Renter Program

CAROLINA SMART HOME - RETNER PROGRAM
Main Applican's Name*

First Name ApplicantLast Name Applicant
Co-Applicant's First Name
Co-Applicant's Last Name
Complete Address (Including city, state, zip code)*
Previous Address (if less than 6 months in current address)
Main Applicant's E-Mail Address*
example@example.com
Main Applicant's SSN*
Main Applicant's DOB*
Main Applicant's Cell Phone Number*
Co-Applicant's E-Mail Address
example@example.com
Co-Applicant's SSN
Co-Applicant's DOB
Co-Applicant's Cell Phone Number
HOUSEHOLD ANNUAL INCOME*
$53.99 Essential Package$59.99 Smart Access Home Package$63.99 Smart Home Package
Notes for office
Applicant - Copy of D/L or state ID for verification purposes*

Cancelof
Co-Applicant - Copy of D/L or state ID for verification purposes (Required for Co-applicant)

Cancelof
Customers Signature*

Clear
Date*

MonthDayYear
Date
By choosing to proceed, I agree to the Electronic Communication and E-Sign Agreement, as well as to receive communications by phone or email from Smart Home Pay. Anti-money laundering and counter-terrorism financing laws require that we collect and verify identifying information if you proceed in using Smart Home Pay.

I signed this form on the date listed herein and consented to electronic signature method. A copy was emailed to me. I consent to a standard credit check for approval for the alarm equipment I am purchasing. Upon purchase, I will own the alarm system. Purchase includes professional installation, extended warranty, monitoring of alarm devices (when ADT monitoring agreement is active - separate payment is required), and google video access/storage (when video devices are purchased All sales are final once devices have been installed in the home/business.
THANK YOU FOR YOUR YOUR BUSINESS
GEO Location
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CAROLINA SMART HOME - RETNER PROGRAM

THANK YOU FOR YOUR YOUR BUSINESS