Contract # __________
Purchaser’s Information (All fields are required) Legal Name: ______________________________________________________First, Middle, and Last names required. Cell Phone: _______________________________________________________ SSN: ____________________________________________________________ Physical Address: __________________________________________________ City, State, Zip Code: _______________________________________________ Mailing Address: ___________________________________________________ City, State, Zip Code: _______________________________________________ eMail: ___________________________________________________________ Birth: __ __ / __ __ / __ __ __ __ |
Four personal references are required in the event we are unable to contact you regarding your account. Make sure the people listed below have the ability to reach you. We reserve the right to inform your references of delinquencies and forthcoming repossessions.
Personal Reference #1: Legal Name: _____________________________________________________ First, Middle, and Last names required. Home Phone: ____________________________________________________ Cell Phone: ______________________________________________________ Physical Address: _________________________________________________ City, State, Zip Code: ______________________________________________ Mailing Address: __________________________________________________ City, State, Zip Code: ______________________________________________ eMail: __________________________________________________________ |
Personal Reference #2: Legal Name: _____________________________________________________ First, Middle, and Last names required. Home Phone: ____________________________________________________ Cell Phone: ______________________________________________________ Physical Address: _________________________________________________ City, State, Zip Code: ______________________________________________ Mailing Address: __________________________________________________ City, State, Zip Code: ______________________________________________ eMail: __________________________________________________________ |
Personal Reference #3: Legal Name: _____________________________________________________ First, Middle, and Last names required. Home Phone: ____________________________________________________ Cell Phone: ______________________________________________________ Physical Address: _________________________________________________ City, State, Zip Code: ______________________________________________ Mailing Address: __________________________________________________ City, State, Zip Code: ______________________________________________ eMail: __________________________________________________________ |
Personal Reference #4: Legal Name: _____________________________________________________ First, Middle, and Last names required. Home Phone: ____________________________________________________ Cell Phone: ______________________________________________________ Physical Address: _________________________________________________ City, State, Zip Code: ______________________________________________ Mailing Address: __________________________________________________ City, State, Zip Code: ______________________________________________ eMail: __________________________________________________________ |
The required documents to submit with application for rental consideration are below.
(We do NOT consider Child Support a form of income.)
State-issued ID (w/picture) Proof of income (Bank statement, SSI aware letter, or check stub. If Social Security Card using spouses’ income, the rental application should be in their name.) Utility bill or bank statement with Purchaser’s name AND matching address.
Page | 1 Rent: (verb) to tear or split (something) apart; to rip or break into pieces.
Contract # _______________________
Purchaser’s Item(s)
Model # | Serial Number | Used or New | Description of Item |
Payment Cycle: MONTHLY ❑ 1st ❑ 3rd ❑ 20th
# of Months / # of Payments: ______ Payment Amount: $___________
First Payment Date: ____/____/_____ Amount Owed: $_____________
Default date: _______________ Additional Fee of: ________________ Combined/Total Cost of Ownership: $__________________
Associated Rental Fees & Purchaser Terms
Fee Occurrences On Time | ||||
SERVICES | ||||
Delivery/Installation Fee (Inside Store City Limits) | $200.00 | This is required to ensure item(s) are not damaged during trans or install. This fee is split across your payments. | ||
Delivery Free (Outside Store City Limits) | $1 per mile to and from | |||
ONE CHANCE - Default Late Fee One-time per period | $10/daily | This may ONLY be used ONCE throughout life of Agreement. $10 add per day late. | ||
Attorney Fees | MO Rents will seek funds through civil court to collect balance plus all reasonable costs associated with the fund collection, including but not limited to attorney fees, court fees, or any other fees deemed necessary to complete collection activities. | |||
Page | 2 Rent: (verb) to tear or split (something) apart; to rip or break into pieces.
Contract # _______________________
Agreement Terms and Conditions
Rent: (verb) to tear or split (something) apart; to rip or break into pieces.
MO Rents offers a convenient way to purchase the item(s) by breaking down your invoice into smaller, immediately affordable payment installments. By agreeing to the following terms, you are entering into a Purchase Agreement for the item(s) listed above. As the “Purchaser,” you are responsible for making all payment installments.
Conceptual understanding Initial: _____________________
1. Insurance Responsibility: MO Rents does NOT carry insurance on the property throughout the life of the Agreement, or once it is paid in full. If the Purchased Merchandise is stolen, irreparably damaged, or destroyed, the Purchaser is still responsible for the remaining balance on the account, which is due immediately. If merchandise is repairable, the Purchaser is responsible for the reasonable cost of those repairs. Please get in touch with the warranty company, if applicable. MO Rents does not offer repair services.
Initial: _____________________
2. Hardship Clause: No grace period is offered. Once an account becomes past due (one day late) based on the Agreement, collection activities will begin. Purchasers get a “One Chance” default fee of $10/day until the account is brought current. Use wisely.
Initial: _____________________
3. Default: If the account defaults a second time during the life of the Agreement the Purchaser will be placed on our “Do Not Rent To” list. If the account balance is not paid, MO Rents will seek funds through civil court to collect the balance plus all reasonable costs associated with the fund collection, including but not limited to attorney fees, court fees, or any other fees deemed necessary to complete collection activities.
Initial: _____________________
4. Termination: MO Rents may terminate this agreement at any time.
Initial: _____________________
5. Payment Responsibility: The Purchaser is responsible for making installation payments on time until the account is paid in full. Failing to pay as stated within the agreed-upon terms will result in a Default. (Refer back to #3.)
Initial: _____________________
6. No Refunds: There NO refunds of any monies paid in this Agreement.
Initial: _____________________
Page | 3 Rent: (verb) to tear or split (something) apart; to rip or break into pieces.
Contract # _______________________
Agreement Terms and Conditions
(continued)
Rent: (verb) to tear or split (something) apart; to rip or break into pieces.
7. Delivery/Installation: MO Rents delivers and installs all item(s) listed in this agreement. Why? To ensure prevention of any self-installation errors, issues due to improper site preparation, or the lack of necessary tools/accessories/components required for proper installation. The Delivery/Installation fee is $200 and will be included in your overall grand total which will be split across the above number of months. For deliveries outside of the city limits is an additional ($1/mi) one dollar per mile to and from the destination. Not to exceed 50 miles from our MO Rents location.
MG Example: Cabool City Hall: 11 miles to site + 11miles return to base = 22 miles = $22 + $200 MG Delivery = $222 Initial: _____________________
8. No deliveries scheduled on Saturdays, Sundays, or Mondays. We schedule deliveries according to the end destination to complement a pre-existing route. Example: If you live east of Mountain Grove, we will schedule your delivery on a day when we are already going east.
Initial: _____________________
Purchaser Signature:_______________________________________
Signature Date:___________________________________________
Page | 4 Rent: (verb) to tear or split (something) apart; to rip or break into pieces.