Rental
Order Form		 Please print out the rental order form and fax it to one of our convenient locations, or come by one of our showrooms and speak with one of our friendly staff.

Personal Information
First Name
Last Name
Middle Initial   Maiden Name
Date of Birth
SSN
Phone Number (please include area code)
E-Mail Address
Driver's License Number   State
Current Address
Street Address   Apartment 
City
State
Zip Code     Rent   Own   How long at this address
Landlord    Landlord's Phone Number
Previous Address
Street Address   Apartment 
City
State
Zip Code     Rent   Own   How long at this address
Landlord Landlord's Phone Number
Spouse/Relative/Roommate Living With You
First Name
Last Name
Middle Initial   Maiden Name
Date of Birth
SSN
Driver's License Number   State
Relationship  
 Employer
Company
Address
City, State, Zip    
Phone (Please include area code)
How Long Years   Months
Department or Title  
Salary   Payday
If Military, Rank    Year in Service   Serial Number   DOS
 Spouse/Relative/Roommate Employer
Company
Address
City, State, Zip    
Phone (Please include area code)
How Long Years   Months
Department or Title  
Salary   Payday
 

 
Other Income  
Utilities in the Name of  
Auto Make and Model   Year   License Plate Number State
 

 
Nearest Relative Not Living With You
Address
City, State, Zip    
Phone (Please include area code)
Relationship

References
(please name at least one immediate relative)

Name
Address
City, State, Zip    
Phone (Please include area code)
Relationship (i.e., friend, co-worker, etc.)
Name
Address
City, State, Zip    
Phone (Please include area code)
Relationship (i.e., friend, co-worker, etc.)
Name
Address
City, State, Zip    
Phone (Please include area code)
Relationship (i.e., friend, co-worker, etc.)
Name
Address
City, State, Zip    
Phone (Please include area code)
Relationship (i.e., friend, co-worker, etc.)
Name
Address
City, State, Zip    
Phone (Please include area code)
Relationship (i.e., friend, co-worker, etc.)
How did you hear about Southern Home Rentals?
Radio  TV  Newspaper  Direct Mail  Referral  Friend  Other
Have you rented from any other rental company?   Yes  No 
Which one?
Any other comments? 

PLEASE READ BEFORE SUBMITTING FORM:  I certify the information supplied herein is true and correct to the best of my knowledge.  I authorize verification on all information contained herein, including contact with any persons or organizations listed herein.  I fully release all parties from all liability for any damage that may result.  Any false statement herein is reason for rejection of this order.  I acknowledge that I have read and understand the above statement.  Please print out the rental order form and fax it to one of our convenient locations or come by one of our showrooms and speak with one of our friendly staff.