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SCHEDULE PICK UP
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FAQ
ABOUT
PLACE ORDER
Special Order
SCHEDULE PICK UP
Customer Order Form
First Name
*
Middle Name
Last Name
*
Email
*
Phone
*
Salutation
*
Mr.
Ms.
Date of Birth
*
Date Format: MM slash DD slash YYYY
Drivers License Number
*
Drivers License State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Referred by
*
LOCATION
Property Name
*
Address
*
Apt / Unit #
*
City
*
State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
Zip Code
*
What floor will the appliances be on?
*
1st
2nd
3rd
Townhome
EMPLOYMENT INFORMATION
Employer
*
Phone
*
PERSONAL REFERENCE
Name
*
Phone
*
Relationship
*
Parent
Sibling
Roommate
Coworker
Friend
Spouse
Other
INITIAL PAYMENT
Card Holder Name
*
Card Type
*
Visa
MasterCard
American Express
Discover
Credit Card #
*
Expiration Month
*
Expiration Year
*
CVV Code
*
Billing Address
*
Street Address
Apt/Unit #
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
RENTAL INFORMATION
Promo Code
Desired Delivery Date
*
Date Format: MM slash DD slash YYYY
Delivery date is not guaranteed
Est. Rental Period
*
3 months (minimum)
6 months
9 months
12 months
More than 1 year.
Refrigerator
14 cu ft refrigerator - White - $40.00
14 cu ft refrigerator - Black - $50.00
18 cu ft refrigerator - White - $45.00
18 cu ft refrigerator - Black - $55.00
18 cu ft refrigerator - Stainless - $65.00
18 cu ft refrigerator w/ Ice Maker - White - $55.00
18 cu ft refrigerator w/ Ice Maker - Black - $65.00
18 cu ft refrigerator w/ Ice Maker - Stainless - $75.00
22 cu ft refrigerator - White - $85.00
22 cu ft refrigerator - Stainless - $95.00
No Refrigerator
Washer
Full Size Washer - $30.00
Front Load Washer - $60.00
No Washer
Dryer
Full Size Gas Dryer - $30.00
Full Size Electric Dryer - $30.00
Front Load Dryer (GAS) - $60.00
No Dryer
TV
32 in LED TV - $45.00
No TV
Handle Side option
*
Left
Right
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
*
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