MODERN RTO Order form English

Rental/lease application and order form

Please complete all required personal, housing, employment, reference, vehicle, agreement, and signature fields exactly as requested.
Administrative & Applicant Identity
Date

MonthDayYear
Date
Received by
Approved by
Primary - Full Name

First NameMiddle NameLast Name
Primary - DOB

MonthDayYear
Date
Primary - Driver’s License #
2nd Person - Full Name

First NameMiddle NameLast Name
2nd Person - DOB

MonthDayYear
Date
2nd Person - Driver’s License #
Relationship to primary
Email address
example@example.com
Who else have you rented from?
Current Residence
Address
Apt #
City / State / Zip
Residence Type

Other
House Tel #
Please enter a valid phone number.Format: (000) 000-0000.
Cell # Primary
Please enter a valid phone number.Format: (000) 000-0000.
Cell # Secondary
Please enter a valid phone number.Format: (000) 000-0000.
Rent ($)
Landlord Name
Landlord Phone #
Please enter a valid phone number.Format: (000) 000-0000.
Landlord Type

Other
How Long (at current address)
Primary Employment Details
Primary Employer Name
Primary Employer Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Primary Employer Phone
Please enter a valid phone number.Format: (000) 000-0000.
Primary Employer Direct Line
Please enter a valid phone number.Format: (000) 000-0000.
Primary Position/Title
Primary Work Hours
Primary Work Days
Primary Pay Days
Primary Pay Frequency
Primary Date of Hire

MonthDayYear
Date
Primary Monthly Income
Primary Employment Type

Other
Secondary Employment Details
2nd-Person Employer Name
2nd-Person Employer Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
2nd-Person Employer Phone #
Please enter a valid phone number.Format: (000) 000-0000.
2nd-Person Direct Line #
Please enter a valid phone number.Format: (000) 000-0000.
2nd-Person Position/Title
2nd-Person Work Hours
2nd-Person Work Days
2nd-Person Pay Days
2nd-Person Pay Frequency
2nd-Person Date of Hire

MonthDayYear
Date
2nd-Person Monthly Income
2nd-Person Employment Type

Other
References
Reference #1 (Primary Mother) - Full Name

First NameMiddle NameLast Name
Reference #1 (Primary Mother) - Street Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Reference #1 (Primary Mother) - Phone
Please enter a valid phone number.Format: (000) 000-0000.
Reference #2 (Relative) - Full Name

First NameMiddle NameLast Name
Reference #2 (Relative) - Street Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Reference #2 (Relative) - Phone
Please enter a valid phone number.Format: (000) 000-0000.
Reference #3 (Relative) - Full Name

First NameMiddle NameLast Name
Reference #3 (Relative) - Street Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Reference #3 (Relative) - Phone
Please enter a valid phone number.Format: (000) 000-0000.
Reference #4 (2nd Person Mother) - Full Name

First NameMiddle NameLast Name
Reference #4 (2nd Person Mother) - Street Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Reference #4 (2nd Person Mother) - Phone
Please enter a valid phone number.Format: (000) 000-0000.
Reference #5 (Relative) - Full Name

First NameMiddle NameLast Name
Reference #5 (Relative) - Street Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Reference #5 (Relative) - Phone
Please enter a valid phone number.Format: (000) 000-0000.
Vehicle Information
Primary Vehicle - Yr/Make/Model
Primary Vehicle - Color
Primary Vehicle - License Plate
Primary Vehicle - Own
2nd Vehicle - Yr/Make/Model
2nd Vehicle - Color
2nd Vehicle - License Plate
2nd Vehicle - Own
Agreement & Signatures
Agreement & Authorization
EVERYTHING I HAVE STATED ON THIS APPLICATION IS CORRECT TO THE BEST OF MY KNOWLEDGE. I UNDERSTAND THAT YOU WILL RETAIN THIS REQUEST WHETHER OR NOT IT IS APPROVED. YOU ARE AUTHORIZED TO CHECK MY EMPLOYMENT HISTORY, VERIFY RESIDENCE THROUGH MY LANDLORD, AND CONTACT MY PERSONAL REFERENCES. SOCIAL SECURITY NUMBERS ARE REQUIRED FOR IDENTIFICATION AND FRAUD PREVENTION. ACCESS TO RECORDS CONTAINING SOCIAL SECURITY NUMBERS IS LIMITED TO MODERN RENT TO OWN AGENTS AND EMPLOYEES
Primary Signature
Primary Signature Date

MonthDayYear
Date
Secondary Signature
Secondary Signature Date

MonthDayYear
Date
Primary SS#
Secondary SS#
Should be Empty:

Rental/lease application and order form

Administrative & Applicant Identity

Current Residence

Primary Employment Details

Secondary Employment Details

References

Vehicle Information

Agreement & Signatures