T and T Appliance Rental

First Name*

Middle Name

Last Name*

Email*

Phone*

Salutation*

Mr.
Ms.

Date of Birth*

Drivers License Number*

Drivers License State*

Referred by*

LOCATION

Property Name*

Address*

Apt / Unit #*

City*

State*

Zip Code*

What floor will the appliances be on?*

EMPLOYMENT INFORMATION

Employer*

Phone*

PERSONAL REFERENCE

Name*

Phone*

Relationship*

INITIAL PAYMENT

Card Holder Name*

Card Type*

Credit Card #*

Expiration Month*

Expiration Year*

CVV Code*

Billing Address*

Street Address Apt/Unit # City State ZIP Code

RENTAL INFORMATION

Promo Code

Desired Delivery Date*

Delivery date is not guaranteed

Est. Rental Period*

Refrigerator

Washer

Dryer

TV

Handle Side option*

Monthly Rate

Setup Fee

(One-time fee covering delivery, installation and pick up.)

Price: $85.00

Total Initial Payment

$0.00

Special Instructions

AGREEMENT

Terms and Condition*

Yes, I agree. The above items are an accurate listing of the lease property (hereinafter called "Leased Property"). Resident agrees to lease such from T&T Appliance Rental and to keep the Leased Property at the address above pursuant to the terms and conditions set forth herein. In the event that the Resident removes Leased Property from the above address, T&T is not responsible for damage or injury due to misuse or improper operation / installation of Leased Property and Resident bears full responsibility for said damages / injuries as well as any damages to Leased Property itself. Minimum rental term is 3 months and will continue on a month to month basis thereafter until termination of Rental Agreement.

Termination of Rental Agreement*

Yes, I agree. Resident may terminate this lease following the minimum rental term by giving fifteen (15) days notice to T&T. Failure to give fifteen (15) days notice will result in a prorated charge not to exceed fifteen (15) days of rent. T&T may terminate lease with thirty (30) day written notice for nonpayment of rent. Upon termination, Resident will make the Leased Property available to T&T at a time that is convenient to T&T and will permit T&T or its agents access to Resident premises for the expressed and sole purpose of recovering Leased Property.

Permission to Enter*

Yes, I agree. I hereby grant T&T Appliance Rental permission to enter the premises listed above for the expressed and sole purpose of delivering and or recovering Leased Property. I further authorize the building owner or his representative to permit access to and release said Leased Property to T&T and hold such owner and / or representatives harmless for their actions, or any other actions, from such entry.

Customer Acknowledgement*

Yes, I agree. I certify that I have read and accept the terms and conditions above and grant T&T Appliance Rental permission to enter the above premises for the expressed and sole purpose of delivering / recovering the Leased Property. In the event that my account becomes past due, I specifically authorized you to charge all outstanding amounts due and any other costs reasonable to recover Leased Property, if applicable, to my credit card on this application, and agree to keep said credit card in good standing for the duration of this lease.

Customer Name*

Signature*

CAPTCHA

Customer Order Form

LOCATION

EMPLOYMENT INFORMATION

PERSONAL REFERENCE

INITIAL PAYMENT

RENTAL INFORMATION

AGREEMENT