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ONLINE ORDER FORM

Name*

Maiden Name*

Birthdate*

Sex

Driver's License / State

Address

Apt #

City

State

Zip Code

How Long?

Previous Address (if less than 3 years at above address)

Home Phone*

Cell Phone*

Residence is...

Owned
Rented
House
Apartment
Other

Lessee Email*

Co-Lessee Email

Utilities in Whose Name?

Current Landlord/Mortgage Co.

Monthly Payment

Address

Phone #

Auto Year

Auto Make & Model

Color

Tag #

Where Financed

Payment Amt

Employer

Job Title

Dept.

Shift

Address

Hire Date

Supervisor

Phone & Extension

Previous Employer

Working

Full Time
Part Time
Not Working

Take Home Pay

Paid

Once a Week
Every 2 Weeks
Once a Month

Day of Week Paid

I Will Make My Payment

By Mail
By Bringing In
Auto Debit (see Store for details)

I Will Make My Payment

Weekly
Monthly

Monthly Payment by

3rd of the Month
17th of the Month

Name of Other Adult in Household

Birthdate

Sex

Driver's License / State

Relationship

Employer

Address

Job Title

Hire Date

Shift

Supervisor

Phone & Extension

Additional Income

Source

Cell Phone

PERSONAL REFERENCES Minimum 5

Name (Parent)

Address

City/State/Zip

Phone

Relationship

Name (Relative)

Address

City/State/Zip

Phone

Relationship

Name (Relative/Friend)

Address

City/State/Zip

Phone

Relationship

Name (Relative/Friend)

Address

City/State/Zip

Phone

Relationship

Name (Relative/Friend)

Address

City/State/Zip

Phone

Relationship

Message*

Palm Coast 386-447-6568 - St Augustine 904-824-9008

*All Order Forms Subject To Final Approval. Credit Is Not A Factor, Just Provable Income & Residence, Along With Reference Verification. Zbest Reserves The Right To Change Service Area Restrictions & Rental Order Form Approving Guidelines At Any Time. We Are Not A Creditor & Offer Rental Purchase Of Various Household Merchandise. Terms May Vary From 4 to 30 Months, Depending On The Item Rented. 120 Days Same As Cash, Allows You To Receive Full Credit Of Rent Paid (Excluding Any Accrued Applicable Fees Listed On Your Rental Agreement) Toward The Purchase Of The Rented Item, Within The 120 Day Period. Upon Renting Beyond The 120th Day, Payouts Are Calculated Per Your Rental Agreement. Cash & Carry Prices, Do Not Include Delivery & Are Subject To Availability... All Rentals Are Governed In Accordance To Florida Statute 812.155 And Can Be Reviewed By Clicking The Following Link: ⇉ FL Statutes Regarding Rental Property ⇇ or For More Information, Please Feel Free To Call Us.

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