AAR145_Aarons 2016 Catalog_V1

38-39 / 39

PLE
Full Name Nickname Date of Birth Social Security No. Driver's License No. State
Address □ Apt □ Home □ Mobile Home State
Secondary Customer's Name *Date of Birth *Driver's License No. *State
Phone Number
Previous Address (If Less Than 3 Years At Above) How Long
DATE INITIALS Person Speaking Move in Date Name on Lease Length of Lease Current Status
Auto Make & Model Year Color License Plate No. State Registered
Auto Financed Through
Bank Name / Location I Have A Checking Account: □ Yes □ No I Have A Savings Account: □ Yes □ No
Job Title / Position □ Full Time □ Part Time □ Temp Hire Date Shift / Business Hours
Paid □ Wk □ Ev. 2 Wks □ Mo Supervisor Phone No. Ext. / Dept.
DATE INITIALS Person Speaking Date of Hire Position Department Message(Yes/No)
*Employer of Secondary Customer (If None, Source of Income) *Hire Date *Shift / Business Hours
*Employer Address *Paid □ Wk □ Ev. 2 Wks □ Mo *Supervisor *Phone No. Ext. / Dept.
DATE INITIALS Person Speaking Date of Hire Position Department Message(Yes/No)
Parent / Relative Street Address City / State / Zip Phone Relationship
DATE INITIALS Address Employment Home Phone Frequency of Contact Message
Relative Street Address City / State / Zip Phone Relationship
DATE INITIALS Address Employment Home Phone Frequency of Contact Message
Relative Street Address City / State / Zip Phone Relationship
DATE INITIALS Address Employment Home Phone Frequency of Contact Message
Reference Street Address City / State / Zip Phone Relationship
DATE INITIALS Address Employment Home Phone Frequency of Contact Message
□ Cash / Check □ Credit Card □ Finance □ Other
□ Yes □ No What rental company? _____________________________
Initials
RELEASE OF INFORMATION TO AARON'S: (PLEASE READ BEFORE SIGNING)
I AM APPLYING FOR A LEASE AND AM OVER EIGHTEEN (18) YEARS OF AGE. Order Taken By: __________ Time _________
Processed By: __________ Time _________
SIGNATURE DATE PHONE SALE □ IN STORE □
Approved By: _______________ (GM)
SIGNATURE DATE Comments: __________________________
Please check any items you might have an interest in later:
□ TV □ Direct Mail □ Big Screen TV/ LCD □ Home Theater □ Refrigerator
□ Former Customer □ Handbill □ Internet □ TV □ Dining Room □ Freezer
□ Radio □ Sporting Event □ Computer □ Bedroom □ Washer / Dryer
□ Sales Flyer □ Friend □ DVD □ Living Room □ Lawn Mower
□ Door Hanger □ Drive By □ Range □ Other ___________________________
Income
$
Employer (If None, Source of Income)
Employer Address
*Occupation
How Long
* Social Security #
Address Name
SOURCE OF INCOME
*Mobile Phone #
In Whose Name are the Telephone / Utilities Whose Name on Lease (If Rented) Home Phone # Mobile Phone #
□ Customer Referral (NAME)___________________________________________
□ Newspaper
□ Other ______________________
YES, I WOULD LIKE TO RECEIVE EXCLUSIVE PROMOTIONAL OFFERS AND INFORMATION ABOUT PRODUCTS AND SERVICES FROM AARON'S OR ITS AGENTS VIA
PRE-RECORDED OR ARTIFICIAL VOICE OR AUTOMATICALLY DIALED TELEPHONE CALLS OR TEXT MESSAGES AT THE NUMBER(S) I PROVIDED ABOVE. I
ACKNOWLEDGE THAT MY CONSENT IS NOT REQUIRED FOR ANY LEASE OR PURCHASE.
How did you
hear about us?
PERSONAL REFERENCES
l Have you ever rented from a rental company?
l How do you normally pay for a transaction like this?
*Income
$
I WILL o MAIL o BRING IN MY PAYMENT ON OR BEFORE THE o 1ST o 15TH
LEASE ORDER FORM
Order by Phone: It's as Easy As 1, 2, 3
1. Call Aaron's
2. Place your order with Aaron's
3. In most cases, Aaron's will deliver in the same day.
The information I have provided on this form is correct. I authorize confirmation of all information that I have provided. For any agreement that I enter into with Aaron's, I consent to Aaron's contacting any
person or company that I have listed above for references or assistance in locating or contacting me, and I fully release all parties from all liability for any damage that may result. For notice of Aaron’s, Inc.’s
privacy practices, see For independently owned & operated locations, ask franchisee about its privacy practices. This order may be rejected if any information provided above is
found to be false. By providing my contact information, I consent to being contacted by Aaron's or its agent at any telephone number, including any cellular number(s), via pre-recorded, artificial voice, or
automatically dialed telephone calls or SMS text messages or at any physical or electronic address I provide to Aaron’s or that Aaron’s obtains for me regarding account management or payments for leased
merchandise. I further consent to Aaron’s contacting me (in person or telephone) at my place of employment regarding payments for leased merchandise.
*Only required for secondary customer.
Other Adult in Household *Email Address
Address on License (If Different Than Current)
□ Landlord
□ Mortgage Company
CUSTOMER INFORMATION
Email Address
Paid
□ Weekly □ Monthly
Monthly Payment
$__________
Payment Amount
$_______________
Relationship
City Zip Code
2014-07-R
Lease order form is subject to change. This is a sample formonly. Completion of actual lease order formmay be required in store.