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Save Time for Day of Install...
Nearest Location *
Product of Interest?
Store Email
Today's Date *

MonthDayYear
HourMinutesAM/PM Option
Taken By (Employee)
Please verify you will have the following documents to provide by day of install?

Valid Driver's LicenseValid Vehicle RegistrationValid Vehicle Insurance CardPay Stub - Proof of IncomeUtility Bill - For Proof of Physical Address (if water, electric, gas, etc. is not in your name, still provide a utility bill in the owners name and bring additional mail item you receive in your name)Debit/Credit Card for Automatic Payments
PERSONAL INFORMATION
First Name*
Last Name*
Date of Birth*

MonthDayYear
Current Address*

Street Address

Apt #

CityState

Zip Code
How Long At Current Address? Estimated*
Cell Phone *
Email*
example@example.com
Landlord's Name or Own Home?*
Landlord's Phone Number

Area CodePhone Number

4 PERSONAL REFERENCES - At Different Addresses
Only 1 Reference can share the Same Address as You.

Other 3 References listed should have different addresses from eachother. If addresses are DUPLICATED we may require an addtional reference to complete your file. You can call, text or provide their address information by time of install.
(1)Close Relative: First & Last Name*
(1) Street Address: Can Provide at time Install
(1) City & State *
(1) Cell *
(1) Relationship to Reference *
(2)Family Member: First & Last Name*
(2) Street Address: Can Provide at time Install
(2) City & State*
(2) Cell *
(2) Relationship to Reference*
(3)Family or Close Friend: First & Last Name*
(3) Street Address: Can Provide at time Install
(3) City & State *
(3) Cell*
(3) Relationship to Reference *
(4)Family or Friend: First & Last Name*
(4) Street Address: Can Provide at time of Install
(4) City & State *
(4) Cell*
(4) Relationship to Reference *
Reminder As you Completed the Reference Section Above - Verify:

Only 1 Reference can share the Same Address as You.

Other 3 References listed should have different addresses from eachother. If addresses are DUPLICATED we may require an addtional reference to complete your file. You can call, text or provide RNR their address information by time of install.

EMPLOYMENT - INCOME INFORMATION
Name of Employer / Where you work*
Where is your work located? Street/Town/Remote*
Contact Number for the location you work at?
What shift or hours do your normally work? (Varies)*
Take Home Pay (Estimate) *
How Long at Job?*
How often do you get paid?*

WeeklyBiweekly - Every 2 Weeks (14 Days)Semi Monthly - Every 15 Days on 2 Certain Dates (Twice Per Month)Monthly - Once per Month on a Certain Date
What Days do you get paid? (Examples: Fridays or 3rd monthly or 1st & 15th)*
Any Other Source of Income: Child Support, Social Security, Retirement, etc.
Amount Received (Estimated)
How Often is this received? ( ie: Monthly on the 1st Weekly on Fridays, etc.)

AUTO INFORMATION
Vehicle Year*
Vehicle Make*
Vehicle Model*
Vehicle Color*
License Plate - Tag #
Owner's Name(s) on the States Vehicle Registration Card / Paperwork*
Purchase Date (Estimated Month/Year)*
If the vehicle has a payment plan: Paid To - Finance Company or Car Lot *
How much is your vehicle payment? or NONE*
Does the Vehicle Loan have a Co-Signer?*

YesNo
If Yes, Full Name of Cosigner
Cosigner's Phone #
Have you ever done Lease to Own or Rent to Own with any other company before?*

YesNo
Phone to Finance Company

GENERAL RELEASE:
The undersigned below hereby consents to the release of information to (RNR) RNR Tire Express. In particular, this release shall permit the disclosure to RNR of such information regarding the undersigned in the possession of any agency or department of any state, government, the United States of America, any reference given, or my (our) present or past landlord, employer or lenders. I (we) understand that certain state and federal laws exist which protect my (our) right of privacy by restricting access to state and federal agency files or files held by third parties. My (our) signature(s) below indicate that I (we) have knowingly and voluntarily waived the protection of state, federal and common law right to privacy laws for the purpose of providing address, employment, motor vehicle or consumer loan information to RNR Tire Express And Custom Wheels. I agree to allow RNR to contact me for any purpose necessary via voice, voicemail, text, and email, and that RNR may utilize autodialer systems and prerecorded calls to contact me on my cell phone or at home at any phone numbers I provide on this form and may subsequently provide to RNR.
Renter's Signature

Clear
OPTIONAL: Requested Day and Time for Installation

MonthDayYear
DateHourMinutesAM/PM Option
Upload Photo of Driver's License

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