New Rental Application

Gill's Inc. Application

Application for rent-to-own services through Gill's Inc.
Personal Information
Name *

Prefix First Name Middle Name Last Name
Birthdate *

Month Day Year
Driver's License/ID *
Must have a Georgia state ID
Social Security Number *
Physical Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Primary Phone Number *

Area Code Phone Number
Alternative Phone Number *

Area Code Phone Number
E-mail *

Residence Information
How would you describe your living situation? *

I rent my home. I own my home. I live in someone else's home.
Whose name is the lease/mortgage/home in? *
Move In Date *

Month Day Year
How long is your lease/mortgage valid for? *
eg. "1 year," "6 months," "30 years," "no lease," etc.
Monthly Payment *
Type "Own" if you own your home.
Current Landlord/Mortgage Company *
Type "Self" if you own your home.
Landlord/Mortgage Company Phone Number *
Type "N/A" if you own your home.

Previous Residence Information
Previous Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Move In Date *

Month Day Year
Move Out Date *

Month Day Year
Previous Landlord/Mortgage Company *
Type "Self" if you owned your home
Previous Landlord/Mortgage Company Phone Number *
Type "N/A" if you owned your home

Income Information
Verifiable Source of Income *
Main place of employment or government benefits. NOTE: Child support and school grants will not be accepted as a verifiable source of income.
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number *

Area Code Phone Number
Position
Leave blank ONLY if you receive government benefits
How long have you been with your current employment? *
Enter "00" if you receive government benefits
Direct Supervisor's Name
Leave blank ONLY if you receive government benefits OR if you do not have any supervisors
Paycheck Amount *
Net pay (bring home) of one paycheck/government award. If your pay varies, use your average pay
How Often *
How often you receive a paycheck/government award
Last Paid *

Month Day Year
Paid Next *

Month Day Year

Questionnaire

The answers you give in this section are for informational purposes only and hold no bearing on your application approval.
How did you hear about us? *
eg. "Facebook," "Google search," "TV," "Passing by," etc.
Did someone refer you to us? *

Yes No
If so, whom?

First Name Last Name
Have you rent-to-owned anywhere else before? *

Yes No
If so, where?
What merchandise/property are you interested in? *

Co-Signer Information
Do you have a co-signer? *

Yes No
Name

First Name Last Name
Birthdate

Month Day Year
Driver's License/ID
Must have a Georgia state ID
Social Security Number
Physical Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Primary Phone Number

Area Code Phone Number
Alternative Phone Number

Area Code Phone Number
E-mail
Relationship to Primary Applicant
eg. "Wife," "Spouse," "Mother," "Boyfriend," etc
Verifiable Source of Income
Main place of employment or government benefits. NOTE: Child support and school grants will not be accepted as a verifiable source of income.
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number

Area Code Phone Number
Position
Leave blank ONLY if you receive government benefits
How long have you been with your current employment?
Leave blank ONLY if you receive government benefits
Paycheck Amount
Net pay (bring home) of one paycheck/government award. If your pay varies, use your average pay
How Often
How often you receive a paycheck/government award
Last Paid

Month Day Year
Paid Next

Month Day Year

Files

Use this time to upload any files that we may need to approve your application. Such files include but are not limited to: copy of driver's license, copy of social security card, copy of most recent pay stub/award letter. NOTE: If you choose not to upload any files at this time, you may be asked to provide them in person later.
Would you like to upload any files?

Yes No
File 1
File 2
File 3
File 4
File 5
File 6

Terms and Conditions

Please read all terms and conditions before signing.
SIGNATURE: By signing and submitting this form, you agree that the information you have provided on this application is correct. You authorize Gill's to completely verify all information that you have provided. Gill's has your express authorization to contact any person, landlord, employer, or company you have listed on this application. This form is an application and may be rejected if you fail to qualify or if any information you have provided is found to be false. Gill's does not require a credit check, but is not exempt from inquiring about credit worthiness. *
CO-SIGNER SIGNATURE: By signing and submitting this form, you agree that the information you have provided on this application is correct. You authorize Gill's to completely verify all information that you have provided. Gill's has your express authorization to contact any person, landlord, employer, or company you have listed on this application. This form is an application and may be rejected if you fail to qualify or if any information you have provided is found to be false. Gill's does not require a credit check, but is not exempt from inquiring about credit worthiness.
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Gill's Inc. Application