Central Rent to Own Order Form
for Residents of the Treasure Valley

 
Personal Information
Full Name: *  NickName:   Date of Birth: *
Soc. Sec. #: *   Driver's Lic. #: *   State: *
Current Residence
Address : * Apt. #:
City : State : * Zip : *
How Long : * Phone #: *
In whose name is Telephone/UItilities:
Whose name on lease if rented :
Other
Cell # : E-Mail Address :
Mailing Address
 Same as Current Residence Address
Address : City : State : Zip :
Landlord Information
Type : Name : * Address : *
City : * State : * Zip : * Phone #: *
Vehicle Information
No Vehicle...
Car Make & Model : Car Year : Car Color :
Car License Plate # : State Registered :
Spouse/Roommate Information
None...
Name : Date of Birth :
Social Security # : Driver's License #:
Driver's License State :
Other Adult in Household Information
Name : Relation :
Employment Information
Unemployed/Social Security...
Employer : * Position : *
Type : * Length : * Hours/Week : *
Employer Address : * Employer City : *
Employer State : * Employer Zip : * Monthly Income :$ *
Pay Dates : * Supervisor : *
Employer Phone : *
Spouse/Roommate Employment Information
Unemployed/Social Security...
Employer : Occupation :
Employment Length : Hours/Week :
Employer Address : Employer City :
Employer State : Employer Zip : Monthly Income :$
Pay Dates : Supervisor Name:
Employer Phone :
Personal References
  Name Address City State Zip Phone Relation
1*
2*
3*
4
5
Another Rental Company
Have you ever rented from another rental company?
Rental Company Name : Year :
RELEASE OF INFORMATION TO CENTRAL (PLEASE READ BEFORE CONTINUING)
The information I have provided on this form is correct. I authorize confirmation of all infomration that I have provided.. You may conact 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) typed name(s) below indicate that for purpose of confirmation, I (we) have voluntarily waived the protetion of all rights to privacy laws. This order may be rejected if any information provided above is found to be false.
Renter 1 Name : * Date : * 
Renter 2 Name : Date :
How did you hear about us?*
Customer Referral:
Newspaper Walk-In TV Direct Mail Yellow Pages
Radio Former Customer Internet Other:
Comments/Special Instructions 
 
* Fields must be complete before submitting this form...
 

 

Instructions

Please fill out this form completely.
Once you click on the "Submit" button below a Central RTO representative will contact you within 48 hours.

Privacy Policy

Central will not rent or sell your information. Your information will be kept private and will only be used as necessary to complete the terms of any agreement you initiate.