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Personal Information

Personal References   (Please do not duplicate addresses and/or phone numbers)

Employment Information  

Auto Information  

Is note co-signed?

General Release

The undersigned below hereby consents to the release of information to (RNR) RNR Tire Express. In particular, this release shall permit the disclosure to RNR of such information regarding the undersigned in possession of any agency or department of any state, government, the United States of America, any reference given, or my (our) present or past landlord, employer, or lenders. I (we) understand that certain state and federal laws exist that protect my (our) right to privacy by restricting access to state and federal agency files or files held by third parties. My (our) signature(s) below indicate that I (we) have knowingly and voluntarily waived the protection of state, federal, and common law right to privacy laws for the purpose of providing address, employment, motor vehicle, or consumer loan information to RNR Tire Express and Custom Wheels. I agree to allow RNR to contact me for any purpose necessary via voice, voicemail text, and email, and that RNR may utilize autodialer and auto-text systems and prerecorded calls to contact me on my cell phone or at home at any phone numbers or email addresses, I provide on this form and may subsequently provide to RNR.*

*To be signed at appointment. Make sure the Leasee and, if applicable, the Co-Leasee are present.

Do not forget to bring the following items with you to your appointment:

  • Driver's License

  • Social Security Card

  • Vehicle Registration

  • Paystub or Proof of Income

  • Utility Bill

After clicking submit, please do not click off application until "Application Submitted" message appears.

Application Submitted

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