Customer Information

Personal References

Source of Income

Release of Information to Action Rent To Own - Please Read Before Signing 

The information I have provided on this form is correct. I authorize confirmation of all information that I have provided. You may contact any person or company that I have listed above and I fully release all parties from all liability for any damages that may result. My (our) signature(s) below indicates that for the purpose of confirmation, I (we) have voluntarily waived the protection of all rights to privacy laws. This order may be rejected if any information provided above is found to be false.

I AM APPLYING FOR RENTAL AND AM OVER EIGHTEEN (18) YEARS OF AGE

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