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Furniture Rental Credit Application
We appreciate your interest in our furniture and houseware rental/lease plan and look forward to serving you. The following information is required before an order can be processed. If an area of the credit application does not apply to you or you have a question regarding it, please leave it blank. We will contact you for missing or additional information when necessary. Thank you. Click here to return to previous page
Lifestyles Furniture Rental Credit Application
Personal Information
Salutation
First Name
Last Name
Date of Birth
    SSN
Driver. License. No.
  State Expires
Billing Addr Line 1

Billing Addr Line 2

City
 State Zip
Country
 US Other

Current Address
If different from billing address

Phone
 Hme Cel Fax Office
Email
Employment Information
Employer
Business Address
Business Phone
   Ext Best Hours to Call
Title/Occupation
Other
Employment
Information

  How long        Monthly Salary

Supervisor

      Phone         Extension

Location Information
If moving, are you moving with your company?
 No
Length Of Stay
 3-6 months   more than 6 months
Delivery Date
Closed Sat. & Sun.
Preferred   Approximate

 

Delivery Address

Name of Apartment Complex or housing development if known

Preferred contact methods
Phone:    Home Cell Bus Fax Email
Services I am
interested in
 Residential Furniture-Rental
How did you hear
about us
Apt. complex
Phone Book
Internet
Referral 		Other

Additional information:

I certify the information given on this application is true and correct and authorize Lifestyles furniture Rental or its agents to investigate references herein listed or statements or other data from me or any other person pertaining to my credit or financial responsibility. Acceptance of this application is subject to credit approval.

For your convenience we offer autopay on all major credit cards.

By Submitting this credit application, you agree to the above terms and conditions

 I Agree     Date        

3985 East Patrick Lane
Las Vegas, Nevada 89120
Phone (702) 450-3724    Fax (702) 450-3725
© 2005 Lifestyles Furniture Rental, Las Vegas, Nevada