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
MAIDEN 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
Do you own or rent your home.? Please tick.
	Rent? Own?
LANDLORD
LANDLORD ADDRESS
LANDLORD PHONE
PREVIOUS ADDRESS
HOW LONG?	YEARS MONTHS

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

EMPLOYMENT STATUS
WHERE EMPLOYED

POSITION
HOW LONG? YEARS MONTHS
ADDRESS
PHONE NUMBER EXT.

CO-RENTER INFORMATION

SURNAME NAME
MAIDEN NAME
FIRST NAME
MIDDLE NAME
DRIVERS LICENSE
BIRTH DATE (DAY/MONTH/YEAR)
PHONE
MOBILE
EMAIL
PREVIOUS ADDRESS
HOW LONG?	YEARS MONTHS
ALLOW CREDIT CHECK (Permission to do a credit check?)

CO-RENTER EMPLOYMENT STATUS
WHERE EMPLOYED
POSITION HOW LONG? YEARS MONTHS
ADDRESS
PHONE EXT.

REFERENCES

Next of Kin

N.O.K. NAME
RELATIONSHIP
ADDRESS
HOME PHONE
MOB PHONE

Co-Renter Next of Kin

N.O.K. NAME
RELATIONSHIP
ADDRESS
HOME PHONE
MOB PHONE

REFERENCES: People who know you well.
References are not to be mentioned in above: Eg. Next of Kin.

Valid example: Brothers and Sisters or
Close Friends, must NOT living with you and must be over the age of 18.

Reference 1

REFERENCE NAME
RELATIONSHIP
ADDRESS
HOME PHONE
MOB PHONE

Reference 2

REFERENCE NAME
RELATIONSHIP
ADDRESS
HOME PHONE
MOB PHONE

Reference 3

REFERENCE NAME
RELATIONSHIP
ADDRESS
HOME PHONE
MOB PHONE

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CO-RENTER INFORMATION

CO-RENTER EMPLOYMENT STATUS WHERE EMPLOYED POSITION HOW LONG? YEARS MONTHS ADDRESS PHONE EXT.

REFERENCES

CO-RENTER EMPLOYMENT STATUS
WHERE EMPLOYED
POSITION HOW LONG? YEARS MONTHS
ADDRESS
PHONE EXT.