Preferred Store

Store

Renter Information

Renters First Name

Renters Last Name

Sex

Birth Date

Social Sec #

Drivers License Number

Mailing Address

Street Address

City

State

Zip

Home Phone

Cell Phone

Email Address

Renter Employer/Income

Renters Employer/Source of Income

Address

Phone

Job Title

Take Home pay

Take home pay Amount

Length of Employment

Pay Day

Co-Renter Information

Co-Renters First Name

Co-Renters Last Name

Sex

Birth Date

Social Sec #

Drivers License Number

Employer/Source of Income

Take home pay Amount

Release Of Information To Majik Rent To Own: (Please Read Before Signing)

The Information I(we) have provided on this form is correct. I authorize confirmation of all information that I(we) have provided. Majik Rent To Own may contact any person or company that is listed above, and I(we) fully release all parties from all liability from any damage that may result. My(our) Signature(s) below indicate that, for the purpose of confirmation, I(we) have voluntarily waived the protection of all rights to privacy laws. I also agree to accept messages from Majik regarding special sales or product offers via US mail, voice, email or text, and understand that I may opt-out at any time. This order may be rejected if any information provided above is found to be false.

FOR RENTER
I am applying for rental, and am over 18 years of age.

FOR CO-RENTER
I am applying for rental, and am over 18 years of age.