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MAJIK RENT-TO-OWN RENTAL ORDER FORM


    INFORMATION ABOUT YOU:
First Name*
Last Name* Soc Sec* (No dashes) Birth Date* (mm/dd/yyyy)
Phone*   Cell   Other
Do you Rent or Own your home?*  
Please provide your current Pennsylvania address:
Address* City*
State*
PA
 Zip* 
How long?*  
Please provide your previous address if you lived at current address for less than 2 years!
Prev Address City
State
 Zip 
How long?  
    LANDLORD / MORTGAGE COMPANY:
Landlord or Mortage Company:*      Phone*
Address* City*
State*
 Zip* 
Will he/she give you a good reference?*
Why?* 
    PERSONAL REFERENCES:  (Must be LOCAL - PA - See important information enclosure!)
Nearest Relative (not living with you):*      Phone*
Address* City*
State*
 Zip* 
Relation*  
Another Friend/Relative:*      Phone*
Address* City*
State*
 Zip* 
Relation*  
Another Friend/Relative:*      Phone*
Address* City*
State*
 Zip* 
Relation*  
    EMPLOYMENT INFORMATION:  
Employer*  
    Dates Employed*   From:
To:  
  
Position / Occupation:*      Gross Pay*
Address* City*
State*
 Zip* 
Phone*   
How often do you receive your income?*
  
    AUTOMOBILE INFORMATION:  
Make Year   Color
Make Year   Color
    ITEMS(s) YOU WOULD LIKE TO RENT:  
Name:*      
    IMPORTANT INFORMATION:  
1. You should receive a response regarding your rental application within 24 hours (excluding Sunday). A customer service associate will contact you via phone.
 
Please enter your E-mail address if you would like to subscribe to our newsletter:    
 
2. If your application is approved you will need to visit the store nearest you to sign the rental agreements. You must provide a valid PA License or PA ID card.
 
3. We use electronic check acceptance and only accept personal checks up to $350!      
4. Personal references. We PREFER local references from Pennsylvania. Out-of-state references MAY cause problems in approval of application.
5. The first item you rent (as a new customer) MUST be delivered to you!      
    SIGNATURE::  
By signing below, I certify that the information on this application is true, correct, and complete. I certify that I am 18 years or older, and I am legally capable of entering into a contract. I give my permission to all listed references and to all creditors to release all information about myself, and my credit history.
    Please, Type "Agree"* and click Submit button below
The entry marked "*" must be required!