Pensacola Lease Order Form

Personal Information

Leasee's First and Last Name

Leasee's Social Security #

Leasee's Driver's License Number

Birthday

Co-Leasee's First and Last Name

Co-Leasee's Social Security #

Co-Leasee's Driver's License Number

Birthday

Street Address

City

Region/State/Province

Postal / Zip code

Previous Address

Home Phone

Mobile Phone

Co-Leasee's Phone

Landlord's Name (if applicable)

Landlord's Phone

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

Mother/Father

Address

Phone

Other Relative

Address

Phone

Friend/Relative

Address

Phone

Friend/Relative

Address

Phone

Friend/Relative

Address

Phone

Friend/Relative

Address

Phone

Employment Information

Leasee's Employer

Phone with extension

Dept./Div./Shift

Supervisor Name

Supervisor's Number

How long have you been employed here?

Co-Leasee's Employer

Phone with extension

Dept./Div./Shift

Supervisor Name

Supervisor's Number

How long have they been employed there?

Auto Information

Year

Make

Model

Color

Tag #

Vehicle's Owner's Name

Purchase Date

Automobile Payment

Paid to:

Is note co-signed?

Yes

If yes, full name of cosigner

Cosigner's Phone Number

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

Personal Information

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

Employment Information

Auto Information

General Release

*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.