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With
National TV Sales & Rental

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Store

Renter Information

Renters First Name *

Renters Last Name *

Cell Phone *

Email Address *

Birth Date

Home Phone

Street Address *

City *

State *

Zip *

Renter Employer/Income

Renters Employer/Source of Income *

Address *

Phone *

Take Home pay *

Take home pay Amount *

Length of Employment *

Co-Renter Information

Co-Renters First Name

Co-Renters Last Name

Birth Date

Employer/Source of Income

Take home pay Amount

Personal References

Name *

Phone *

Relationship *

Name *

Phone *

Relationship *

Name *

Phone *

Relationship *

RELEASE OF INFORMATION TO National TV Sales And Rental: (PLEASE READ BEFORE SIGNING)

The Information I(we) have provided on this form is correct. I authorize confirmation of all information that I(we) have provided. National Sales & Rental may contact any person or company that is listed above, and I(we) fully release all parties from all liability from any damage that may result. My(our) Signature(s) below indicate that, for the purpose of confirmation, I(we) have voluntarily waived the protection of all rights to privacy laws. I also agree to accept messages from National Sales & Rental regarding special sales or product offers via US mail, voice, email or text, and understand that I may opt-out at any time. This order may be rejected if any information provided above is found to be false.

FOR RENTER
I am applying for rental, and am over 18 years of age.

FOR CO-RENTER
I am applying for rental, and am over 18 years of age.

Please Respond to the Following Question and Prove You're A Human

Some restrictions may apply. Pictures shown are for illustration purposes only. Not responsible for typographical errors. Models and styles may vary by location. Merchandise may be new or previously rented. This is a rental purchase agreement. Some restrictions and additional fees may apply to the rates listed. Products vary in rate and term. Example: *$69.99 for 18 months = $1,259.82 plus sales tax and optional fee programs. No ownership rights are acquired until the total amount is paid or early buyout option is exercised. Special pricing while supplies last. Certain items may be excluded. See store for details. Offer expires March 31, 2026 © 2026 National TV Sales & Rental

Get Pre-Approved With With National TV Sales & Rental

Preferred Store

Renter Information

Renter Employer/Income

Co-Renter Information

Personal References

Get Pre-Approved
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With
National TV Sales & Rental