National Rental Form

Applicant #1

Name

First Last

Date of birth

Email

Home Phone

Cell Phone

Address

Street Address Street Type City Province Postal Code

At this address since?

Landlords name

Landlords Phone

Do you have a previous address?

Previous Address

Street Address Street Type City Province Postal Code

How long at this address?

Landlords Name

Landlords Phone

Source of income

Source of Income

Check all that apply

Monthly Income

Name of Company

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Supervisors Name

Number of years

Applicant #2

Is there a second applicant?

Name

First Last

Date of birth

Email

Home Phone

Cell Phone

Address

Street Address Street Type City Province Postal Code

At this address since?

Landlords Name

Landlords Phone

Previous Address

Street Address Street Type City State / Province / Region ZIP / Postal Code Country

How long at this address?

Landlords Name

Landlords Phone

Source of Income

Check all that apply

Monthly Income

Name of company

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Supervisors Name

Number of years

Reference 1

1 family, 3 personal

Name

First Last

Phone

Relationship

How Long have you known them for?

Address

Street Address Address Line 2 City Province Postal Code

Reference 2

Name

First Last

Phone

Relationship

How Long have you known them for?

Address

Street Address Address Line 2 City Province Postal Code

Reference 3

Name

First Last

Relationship

How Long have you known them for?

Phone

Address

Street Address Address Line 2 City Province Postal Code

Reference 4

Name

First Last

Phone

Relationship

How Long have you known them for?

Address

Street Address Address Line 2 City Province Postal Code

Other

How did you hear about National Rent-to-Own?

Have you ever rented from National Rent to Own before?

Have you ever rented from any other rental companies before?

Where?

I hereby give National Rent-to-Own Ltd. the authority to verify the information provided and I also allow the investigation of my past payment history. I understand that from time to time, National Rent-to-Own may send me emails and/or mail. I also understand that denial would be without prejudice.*

I agree