Lease Application

Applicant Information

Full Name*

Date of Birth*

SS #*

DL #*

State*

Co-Lessee's Full Name

Date of Birth

SS #

DL #

State

Address*

Apt #

City*

State*

Zip Code*

How Long*

Home Phone

Mobile Phone*

Whose Name Are Phone / Utilities In*

List all Names On Lease for your Residence*

Landlord Name*

Address*

Phone*

Monthly Payment*

Length of Lease*

Previous Address (if less than three years at above)

How Long

Address on Your License or ID*

Email Address*

Vehicle Make & Model

Auto Year

Auto Color

License Plate #

State Registered

Paid To

Phone

Payment Amount

Co-Signer Name

Co-Signer Phone #

What other companies have you used for Lease-to-Own?

What did you Lease?

Location of other store?

Source of Income

Employer*

Position*

Hire Date*

Shift/Business Hours*

Employer Address*

Income*

Income Schedule*

Supervisor*

Supervisor Phone #*

Spouse or Roommate Name

Employer/Position

Hire Date

Shift/Business Hours

Employer Address

Income

Income Schedule

Supervisor

Supervisor Phone #

References

Reference Name

Address

Phone Number

Relationship

Reference Name

Address

Phone Number

Relationship

Reference Name

Address

Phone Number

Relationship

Reference Name

Address

Phone Number

Relationship

Reference Name

Address

Phone Number

Relationship

Consent

Initials:*

I give my consent to receive both automated/pre-recorded and manual calls and text messages from SmartWay/SmartWheels regarding my account and/or sales promotions at any of my contact numbers. RELEASE OF INFORMATION TO SMARTWAY/SMARTWHEELS: (PLEASE READ BEFORE SIGNING) The information I have provided on this form is true and correct. I authorize SmartWay/SmartWheels (the "Company") to verify this information by any manner, including but not limited to automated data sources such as Accurint, contacting my References, Landlord, Mortgage Company, Employer, and any other person or entity listed on this form. For every agreement that I enter into with the Company, I consent to the Company contacting any person or entity that I have listed above for references or assistance in locating or contacting me, and I fully release all parties from all liability for any damage that may result. My (our) signature(s) below indicate that for purpose of confirmation, I (we) have voluntarily waived the protection of all rights to privacy laws. This order may be rejected if any information provided above is found to be false or unverifiable. By providing my telephone number(s), including any cellular number(s), and my email address, I consent to receiving calls (both live and automated), texts and emails from the Company regarding my agreement(s). I also authorize my landlord and/or any person or entity listed here, to grant access to my residence and/or vehicle for the sole purpose of recovering Company’s property and expressly release the Company and any other person or entity listed on this order form or otherwise referred to herein from all liability for any damage that may result. I AM APPLYING FOR A LEASE AND AM OVER EIGHTEEN (18) YEARS OF AGE.

Signature*

Date*

Co-Lesee Signature

Date

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