| Name | Age | Birth date | Social Security No. |
| Customer | . | . | . | ||
| Spouse/Co-Renter | . | . | . | ||
| Present Address | Apt No. | City, State | Zip | How Long have you lived here? |
|
| Previous Address | Apt No. | City, State | Zip | How Long have you lived here? |
|
| Apt.Name, Landlord or Mortgage Co. Name | Address | Their Phone No. |
| Home Phone No. | Message Phone No. and name of contact | Hometown of renter |
| Employment and Income |
| Customer Employer | . | Address | Phone No. | ||
| Occupation | Supervisor | Shift | City,State,Zip | How
Long have you worked there? |
|
| Income Amounts | Dates Paid | (_)Weekly
(_)Monthly (_) Bi-Weekly (_)Other______ |
. | ||
| Employer of Spouse or Co-Renter | Address | Phone No. | |||
| Occupation | supervisor | Shift | City,State,Zip | How
long have you worked there? |
|
| Income | Payday | Dr. License No. | Hometown of Co-Renter | ||
| Reference | Relationship | Address | City,State, Zip | Phone No. |
| . | . | . | . | . |
| . | . | . | . | . |
| . | . | . | . | . |
| . | . | . | . | . |
| Oldest Child living at home? | Name of School they attend and age | |||
| Credit Reference (Bank Card) | Account No. | Expiration Date | Name of Bank |
| . | . | . | . |
| Automobile Information |
| Make | Model | Year | Color |
| License Plate No. | State in which registered | financed by: | |
| How did you hear about us? |
| (_)Customer referral _______________________________________________________________ | ||||
| (_)Newspaper | (_) TV | (_) Direct Mail | (_) Radio ad | |
| (_)Former Customer | (_) Handbill | (_) Other _______________________________ | ||
| I give Davis Rentals
Inc. permission to verify and information given: |
X_____________________________________ |
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