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Vendors
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Renters Name
*
First
Last
Date of Birth
*
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Social Security Number
*
Address
*
Address Line 1
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Rent or Mortgage Amount
*
Mortgage/Apartment Complex/or Landlord Name / Address / Phone
*
How Long at Current Residence (Years/Months)
*
Home Phone
Cell Phone
*
Email
*
Facebook / Social Media Contact Info
*
If not applicable, type None
Previous Address (Indicate None if Current Address is more than 2 years)
*
Address Line 1
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Previous Landlord - Name - Address - Phone if Less than 2 Years at Current Residence (Indicate None if more than 2 Years)
*
Current Employer or Source of Income
*
Position
*
Address Line 1
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
How Long (Years/Months)
*
Business Phone / Extension & Supervisor Phone / Your Days Off
*
Monthly Income
*
2nd Monthly Income & Source (If Any)
Previous Employer if Less than 2 Years - Name / Address / Phone / Position (Indicate None if not applicable)
*
Reference 1
*
First
Last
Address + Phone + Relationship
*
Reference 2
*
First
Last
Address + Phone + Relationship
*
Reference 3
*
First
Last
Address + Phone + Relationship
*
Co-Renter Name - If Any
First
Last
Date of Birth
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YYYY
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2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Social Security Number
Cell Phone
Email
Facebook / Social Media Contact Info
If not applicable, type None
Co-Renter Employer or Source of Income
Position
Address Line 1
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Business Phone / Extension & Supervisor Phone / Your Days Off
How Long (Years/Months)
Monthly Income
2nd Monthly Income & Source (If Any)
Item(s) / Product Request
*
Signature - Use Mouse to Sign
*
Clear Signature
I (we) promise that the information I have provided on this form is correct. I (we) authorize complete verification of all information that I have provided. Nations Rent-To-Own Sales & Leasing (Nations), it's employee(s) and/or assigned agent(s), may contact any person, employer, landlord, utility, cash advance/payday, or rental company, and I (we) fully release and hold harmless all parties from all liability for any damage that may result in the information given in connection with this rental/lease application, and/or subsequent contract(s). My (our) signature(s) below indicates that for purpose of verification, qualification, and collections. Nations or any assignees may also contact me regularly on my landline(s) or cell phone(s), by SMS, MSCM, FACSIMILE, e-mail(s), or social media, using automated prerecorded telephone call, text messages, and/or emails regarding payments, future appointments, and services. Nations may contact me on any of the phone numbers, e-mail addresses, social media, home or work addresses I've provided to Nations and any Assignees. This document is an application to rent/lease and may be rejected if I (we) fail to qualify or if any information provided above is found false and/or misleading.
Co-Renter Signature - Use Mouse to Sign
Clear Signature
I (we) promise that the information I have provided on this form is correct. I (we) authorize complete verification of all information that I have provided. Nations Rent-To-Own Sales & Leasing (Nations), it's employee(s) and/or assigned agent(s), may contact any person, employer, landlord, utility, cash advance/payday, or rental company, and I (we) fully release and hold harmless all parties from all liability for any damage that may result in the information given in connection with this rental/lease application, and/or subsequent contract(s). My (our) signature(s) below indicates that for purpose of verification, qualification, and collections. Nations or any assignees may also contact me regularly on my landline(s) or cell phone(s), by SMS, MSCM, FACSIMILE, e-mail(s), or social media, using automated prerecorded telephone call, text messages, and/or emails regarding payments, future appointments, and services. Nations may contact me on any of the phone numbers, e-mail addresses, social media, home or work addresses I've provided to Nations and any Assignees. This document is an application to rent/lease and may be rejected if I (we) fail to qualify or if any information provided above is found false and/or misleading.
Yes, Please send me Emails on Specials and Products
Comment
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