Rent-A-Center Rental Agreement Application

START YOUR ORDER

Complete the order form below, then your store will call to finalize your order and schedule delivery.

Signature Design by Ashley Centiar 5-Piece Counter-Height Dining Set- Room View

Signature Design by Ashley "Centiar" 5-Piece Counter-Height Dining Set
D372-5

*Required

Secure Form

Please complete all required fields

● Please enter your first name.

● Please enter your last name.

● First name cannot contain special characters or numbers.

● Last name cannot contain special characters or numbers.

● Please enter a valid phone number, including area code.

● Please enter your email address.

● Please enter a valid email address.

● Please enter your email address.

● Please verify your email address.

● Please select the best time to call.

● Please enter your address.

● Please enter a valid address. The allowed special characters are: / , - ( ) # & : ; .

● Apartment # format incorrect. The allowed special characters are: / , - ( ) # & : ; .

● Please enter your city.

● Please select an option.

● Please enter a valid city. The allowed special characters are: / , - ( ) # & : ; .

● Please enter your 5 digit ZIP code.

Why do we ask this?

Yes! Send me deals and offers by email.

Preferred Contact Time*

Morning (9 a.m. - noon)

Afternoon (noon - 5 p.m.)

Evening (5 p.m. - 7 p.m.)

Just want your store to contact you?
Submit Contact Information

By clicking continue, you consent to receive calls and/or text messages from, or on behalf of, Rent-A-Center at the number(s) provided, including calls or messages generated by an automated telephone dialing system using artificial and pre-recorded voice or text messages. You acknowledge and agree that text messaging and/or data rates and fees from your mobile carrier may apply. At any time, you can provide written revocation of this consent to the store you selected. Withdrawal of consent will not adversely affect your application or rental agreement.

Employment & References

Please tell us about your current employer and provide two references. This will help us start your order faster.

Employment Information
Why do we ask this?

Round to the nearest whole dollars amount

References
Why do we ask this?

Reference One

Reference Two

Store Location
Why do we ask this?

No Store Assigned*

Please choose a store to continue:

NOTE: This may result in a change in pricing.

By clicking “Submit Without Offer” or “Claim Offer” you certify that the information provided on this form is correct. You understand that Rent-A-Center may not fulfill your order if any of the information provided is inaccurate. You hereby authorize us to contact any reference or place of employment to verify the information. You agree that Rent-A-Center may contact you with information about the products you viewed and other promotions/offers using any email, phone number, or mobile device number provided on this form or updated in the future.

Secure Checkout

Enter Credit or Debit Information

Enter the first name on the card

Enter the last name on the card

Enter a billing address

Enter a city

Select a state

Enter a zip code

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Pay Now : $

15.00

I agree to the Terms & Conditions

Please Wait.

We are processing your information.

START YOUR ORDER

START YOUR ORDER

Signature Design by Ashley "Centiar" 5-Piece Counter-Height Dining Set D372-5

Employment & References

Please tell us about your current employer and provide two references. This will help us start your order faster.

Employment Information Why do we ask this?

References Why do we ask this?

Reference One

Reference Two

Store Location Why do we ask this?

Please Wait.

Signature Design by Ashley "Centiar" 5-Piece Counter-Height Dining Set
D372-5

Employment Information
Why do we ask this?

References
Why do we ask this?

Store Location
Why do we ask this?