Rto Application

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Complete Rto Application with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

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RTO APPLICATION

Personal Information

Name

Maiden Name

DOB

Driver’s License #

SS#

DL State

Address

City/State/Zip

 Landline

 Cell

Phone

Work Phone + Ext.

Do you:  Own

 Rent

Utilities in whose name:

How long at current address?

Previous Address

City/State/Zip

(if less than 3 mo. at current)

Landlord:

Address

City/State/Zip

Phone

HOW DID YOU HEAR ABOUT US?

Employment

Employer

Address

City/State/Zip

 Full Time

Job Title

Hire Date

Business Hrs

 Part Time

Supervisor

Phone + Ext.

Day of Week Paid

Personal Annual Income

Pay Period:  Weekly

 Every 2 Weeks

 Monthly

Take Home Pay

Additional Income

Source of Additional Income:

Household

Which of the following are living in your household?

What is the total annual household income BEFORE taxes?

 Mother

 Father

 Grandmother

 Grandfather

 Under $10,000

 $41,000 to $50,000

 Spouse

 Fiancé(e)

 Friend

 $10,000 to $20,000

 $51,000 to $60,000

 Children

 $21,000 to $30,000

 $61,000 to $70,000

How many? _________

 Other

 $31,000 to $40,000

 Over $71,000

Explain:

 Single

 Married

 Divorced

 Legally Separated

 Widow/Widower

Are You:

Personal References

(Please include at least 2 Relatives and 2 Non-Relatives. ALL 6 References must be filled in.)

Name

Address

City/State/Zip

Phone

Relationship

The undersigned below hereby consent(s) to the release of information concerning my (our) address or location to EZ Own Auto Source. This release shall

permit the disclosure to EZ Own Auto Source of such information regarding the undersigned in the possession of any agency or department of any

state/government or the United States of America, or of any other person or agency, or my (our) current or past employer. This release shall be effective for 24

months from the date below. I (We) understand that certain state and federal laws exist which protect my (our) right to privacy by restricting access to state and

federal agency files, or files held by third parties. My (Our) signature below indicates that I (we) have knowingly and voluntarily waived the protection of state,

federal and common law right to privacy laws for the limited purpose of providing address information to dealer.

Renter 1

Renter 2

Date

READ BEFORE SIGNING: I certify that the information supplied by me on this

I have read and understand the statement printed to the left.

form is true and correct. I authorize verification of the truthfulness of all

information contained herein, including contact with any person or firm listed

Name: __________________________________ Date: ________________

above, and fully release all parties from all liability for any damage that may

result. Any false statement made above shall be sufficient basis for rejection

If this order is rejected, I may request the reason(s) for same by sending to the