PURCHASE DISCLOSURE
RATE DISCLOSURE

Customer Application

Thank you for speeding up the rental process by taking the time now to complete the rental order form. Take a few minutes to fill out the online form with information about you, your employment history and a few references. When you are finished, click the "Submit" button. Your information will be sent to the store you have selected. Upon receipt, a Crusader RTO associate will contact you to help satisfy your needs.

GENERAL INFORMATION

Full Name (First, Middle Initial, Last):

What is the nearest store?

Current Address

Street Address:

City:

State / Zip Code:

Previous Address

Street Address:

City:

State / Zip Code:

Contact Information

Email Address:

Home Phone:

Work Phone:

Cell Phone:

Best Time to Call:

Personal Information

Date of Birth:

Social Security
Number:

Drivers License
State / Number:

Photo Id
State / Number:

Marital Status:

Miscellaneous

Yes No

Are you currently a debtor in a Chapter 7 or Chapter 13 Bankruptcy proceeding?

Position:

Phone Number:

Supervisor:

Supervisor Phone:

Dates Employed:

Shift:

Pay Frequency:

Gross Income:

HOUSING INFORMATION

Rent or Own?:

How Long:

VEHICLE INFORMATION

Tag Number:

Year:

Make:

Model:

Color:

CO-SIGNER INFORMATION

Full Name (First, Middle Initial, Last):

Current Address

Street Address:

City:

State / Zip Code:

Previous Address

Street Address:

City:

State / Zip Code:

Contact Information

Email Address:

Home Phone:

Work Phone:

Cell Phone:

Best Time to Call:

Personal Information

Date of Birth:

Social Security
Number:

Drivers License
State / Number:

Photo Id
State / Number:

Marital Status:

MARKETING INFORMATION (optional)

What is your educational background?

How far do live from our store?

How did you hear about us?

PLEASE READ CAREFULLY - This application is being submitted for rental of new and used property and I certify that all information I have provided is true and complete. By applying for rental authority from CRTO (the “Company”), I authorize the Company, its representatives, agents and assignees, to verify the information and the credit references I have provided, and to obtain credit information both now and in the future for any legitimate purpose associated with this application, including but not limited to reviewing, renewing or collecting on rent. I understand that if the Company approves this application, the terms and conditions applicable to the rental will be set forth in the Customer Agreement, which I agree to read before signing. I understand that I must update my credit information at your request if my financial condition changes. I understand that the Company will retain this application whether or not it is approved.

Signature Date

Customer Application

GENERAL INFORMATION

Current Address

Previous Address

Contact Information

Personal Information

Miscellaneous

PERSONAL REFERENCES

First Reference (Primary Contact)

Second Reference

Third Reference

Fourth Reference

Fifth Reference

Sixth Reference

EMPLOYER

Company Information

HOUSING INFORMATION

VEHICLE INFORMATION

CO-SIGNER INFORMATION

Current Address

Previous Address

Contact Information

Personal Information

MARKETING INFORMATION (optional)