Lease to Own Application

Do not fill

Applicant Information

First Name*

Last Name*

Nickname

Date of Birth*

Gender

Address*

Apt / Floor / Suite

City*

State*

Zip Code*

Housing Status*

Time At Address*

Type of Residence*

Current Mortgage / Rent*

Phone*

Phone Type*

Best Time to Call

Email*

Current Landlord

Current Landlord Phone

Current Landlord Address

Current Landlord City

Current Landlord State

Current Landlord Zip Code

Auto / Vehicle Information:

Auto Year

Auto Make

Auto Model

Auto Color

State - License #

If less than 3 months at current address:

Previous Address

Previous City

Previous State

Previous Zip Code

Previous Landlord

Previous Landlord Phone

Previous Landlord Address

Previous Landlord City

Previous Landlord State

Previous Landlord Zip Code

Employment Information

Employer*

May We Contact You At Work?*

Job Title*

Employer Address*

Employer City*

Employer State*

Employer Zip Code*

Length of Employment (Months & Years)*

Shift

Department

Supervisor

Work Phone (Number & EXT)*

Working*

Salary*

Salary Amount*

Day of Week / Month Paid

Co-Applicant Information

First Name*

Last Name*

Nickname

Date of Birth*

Gender

Phone*

Phone Type*

Best Time to Call

Email*

Auto / Vehicle Information:

Auto Year

Auto Make

Auto Model

Auto Color

State - License #

Employment Information

Employer*

May We Contact You At Work?*

Job Title*

Employer Address*

Employer City*

Employer State*

Employer Zip Code*

Length of Employment (Months & Years)*

Shift

Department

Supervisor

Work Phone (Number & EXT)*

Working*

Salary*

Salary Amount*

Day of Week / Month Paid

Take Home Pay

Additional Income

Source of Additional Income

You must agree to the terms and conditions below:

RELEASE OF INFORMATION TO VANTAGE: Please Read Statement Before Signing

I promise that the information I have provided on this form is correct. By signing below I expressly authorize Vantage to access and share information from and with third parties. You may contact any person or company listed above and I fully release all parties from all liability for any damages that may result. My (our) signature(s) below indicate that for the purpose of verification, I (we) have voluntarily waived the protection of all rights to privacy laws. This order may be rejected if any information provided is found to be false or unverifiable.

I have read and understood the statement.

By your (wether one or more applicants) signature below you also agree to allow Vantage employees to contact the references listed above and your employer(s) to verify your information and to assist Vantage in its collection efforts if you fail to renew the rental agreement or return the merchandise to Vantage on time. This waiver is valid until you revoke it by notifiying Vantage.

Authorized

Yes, I agree to the terms. No, I do not agree to the terms.

Applicant Signature*

Thank you. Your application has been sent!

Richey St.

Uvalde

Lawndale

Applicant Information

Auto / Vehicle Information:

If less than 3 months at current address:

Employment Information

References

Reference 1

Reference 2

Reference 3

Reference 4

Reference 5

Add A Co-Applicant

Co-Applicant Information

Auto / Vehicle Information:

Employment Information

You must agree to the terms and conditions below: