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Renter's Contact Information

  • Female Male

Co-Renter's Information

  • Female Male

Employment Information




Personal References

Must have minimum 2 family members

Other Companies you are renting from or have rented from in the past

Release of Address and Employment Information to Bolin Rental Purchase, Inc. The signature(s) below indicate consent to the release of my(our) address or location to Bolin Rental Purchase. This release will allow the disclosure to Bolin Rental Purchase of information regarding me(us) that is currently in the possession of any agency or department of any government or company or any listed references. I (we) know that there are certain state and federal laws, which protect my (our) right to privacy by restricting access to information held by certain third parties. My (our) signatures below indicate that I (we) have knowingly and voluntarily waived the protection of all state and federal right to privacy laws for the limited purpose of responding to request for information by Bolin Rental Purchase, Inc.

PLEASE READ CAREFULLY! I certify the information on this form is accurate to the best of my knowledge. I authorize verification of the truthfulness of all information contained herein, including contact with any person, firm or agency listed above and agree to release all parties from any liability or damage that may result. I (we) understand that any false information listed herein may result in Bolin Rental Purchase deciding not to transact business with me(us) at this lime.

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