Print out the following credit application and FAX it to (336) 856-1144. Back to Home Page.

Rental Information
Renter's Full Name
Social Security #
Date of Birth
Home Phone
.  .   .  . 
Address
Apt
City
State
Zip
How Long
Work Phone
.  .  .  .  .  .  . 
Previous Address
Apt
City
State
Zip
 (if less than 6 months)
.  .  .  .  .     
Employer
Hire Date
Income
Supervisor
Phone
.  .  .  .  . 
Employer Address
City
State
Zip
Job Title
.  .  .  .   . 
Current Landlord
Address
City
State
Zip
Phone
.  .  .  .  .  . 
Driver's License No.
State
Auto Make/Model
License Number
State Registered
.  .  .  .  . 
Credit References
Relative's Name
Address
City
State
Zip
Relationship
Phone
.  .  .  .  .  .   
Bank Name/Location
Checking Account#
Savings Account#
Phone
.  .  .  . 
Major Credit Card
Account Number
Expiration Date
  
.  .  .   
Creditor
Address
City
State
Zip
Account #
.  .  .  .  .  . 
.  .  .  .  .  . 
.  .  .  .  .  . 

I hereby apply for merchandise rental. I fully understand that this rental is for a minimum initial term of three (3) months. Everything that I have stated in the application is correct. I agree that any falsification of the above information will result in immediate disapproval of my application and constitute a default under my Rental Agreement. You are authorized to check my credit and employment history and to answer inquiries about my credit experience with HAU Furniture Rental and Sales, Inc. I also understand that my merchandise delivery depends on approval of this application.

Signature: ____________________________________ Date: __________________________