Rental Application

Product/Products Required:

Name *

First

Last

Address:

Telephone Number

Mobile:

Email *

Date of Birth (dd/mm/yyyy)

Drivers Licence No.

Nex of Kin, Name *

First

Last

Next of Kin, Address:

Next of Kin, Work Phone:

Next of Kin, Home Phone:

Landlord or Property Manager Name & Telephone:

Leaseholder Name & Telephone:

Credit Reference Name:

Credit Reference, Store:

Terms and Conditions* *

Comment or Message *

Comment

Call now for the best deals in Rental Appliances in Wellington: 04 472 6276