Rentals-R-Us : On-line Application Form

On-line Application Form

Thank you for choosing Rentals-R-Us for delivery in Perth, Western Australia.

Please complete the following form with as much detail as you have available.

ENTER THE PRODUCT & PERIOD (MONTHS) YOU WISH TO RENT FOR:
(if possible please include product description...eg 5Kg washer and 220ltr fridge)

SURNAME NAME
FIRST NAME
MIDDLE NAME

DRIVERS LICENSE
BIRTH DATE (DAY/MONTH/YEAR)

PHONE
MOBILE
EMAIL	May we have your permission to keep your email address on record to notify you of any specials or bargains in the future? Yes
ADDRESS
HOW LONG?	YEARS MONTHS

ALLOW CREDIT CHECK (Permission to do a credit check?)

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