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Preferred Store

Store

Renter Information

Renters First Name *

Renters Last Name *

Cell Phone *

Email Address *

Birth Date *

Social Sec # *

Drivers License Number *

Home Phone

Street Address *

City *

State *

Zip *

Have you rented before? *

Renter Employer/Income

Renters Employer/Source of Income *

Address *

Phone *

Job Title *

Take Home pay *

Take home pay Amount *

Length of Employment *

Pay Day *

Residence Information

Do you rent your residence? *

Landlord Name *

Phone *

Time Lived at Residence *

Co-Renter Information

Co-Renters First Name

Co-Renters Last Name

Phone

Birth Date

Employer/Source of Income

Take home pay Amount

Personal References

Name *

Phone *

Relationship *

Name *

Phone *

Relationship *

Name *

Phone *

Relationship *

RELEASE OF INFORMATION TO Champion Sales And Lease: (PLEASE READ BEFORE SIGNING)

The Information I(we) have provided on this form is correct. I authorize confirmation of all information that I(we) have provided. Champion Sales And Lease may contact any person or company that is lis

FOR RENTER
I am applying for rental, and am over 18 years of age.

FOR CO-RENTER
I am applying for rental, and am over 18 years of age.

Please Respond to the Following Question and Prove You're A Human