Rental Agreement Credit Application

Intake Form

Please fill out the form below:

"*" indicates required fields

Piano

Add Piano...

Select From Catalog

Add New Piano

Add Customer Without Piano

Add a Piano from the Catalog

Piano

Add a Piano to the Catalog

Product Title

Price ($)

SKU

Customer

Note

Will be added to product content along with Customer, Sales Associate, and current date.

Rentee Basic Information

Name*

First Last

Email:*

Username*

Use only letters, numerals, or "-" (dash) or "_" (underscore).

Password*

Enter Password Confirm Password

Address

Street Address Address Line 2 City State ZIP Code

Phone

Number of Floors

Please enter a number from 1 to 100.

(the floor that the piano will be on)

Rental Associate

(The name of the person who helped you, if any.)

Credit Application

This form is to help us assist you in renting a piano. For more information on renting a piano please refer to the rental plan page.

Date of Birth

Spouse's Name

Residence

Rent or Own:

I own my residence

My residence is rented

Years at your current address

Monthly mortgage or rent

Driver's License Number

State

Social Security Number

Employment Information

Employer

Position

Address of Employer

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Employer Phone Number

Monthly Income

Co-Applicant

Name

First Last

Relationship to Applicant

Social Security Number

Date of Birth

Employer

Position

Employer Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Employer Phone Number

Monthly Income

Payment Information

Monthly Recurring ChargeHandled through ACH

Routing Number

Account Number

Bank Name

Name on Account

Credit/ACH Authorization

Customer Can Sign Digitally Here

Applicant Credit Check and ACH Authorization

To process your order, we will need to check your credit. Your signature below using mouse, stylus, touchscreen, or other device will give us permission to contact credit rating services and, upon finalization of a Rental Agreement, to use your ACH bank information for payment processing.

Co-Applicant Credit Check

Check Co-Applicant Credit

Co-Applicant Credit Check Authorization