Gill's Inc. Application
Application for rent-to-own services through Gill's Inc.
Personal Information
Name
*
Mr.
Mrs.
Ms.
Prefix
First Name
Middle Name
Last Name
Birthdate
*
-
Month
-
Day
Year
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Driver's License/ID
*
Must have a Georgia state ID
Social Security Number
*
Physical Address
*
Street Address
Street Address Line 2
City
State
Zip Code
Primary Phone Number
*
-
Area Code
Phone Number
E-mail
*
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Residence Information
Whose name is the lease/mortgage/home in?
*
Move In Date
*
-
Month
-
Day
Year
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How long is your lease/mortgage valid for?
*
eg. "1 year," "6 months," "30 years," "no lease," etc.
Current Landlord/Mortgage Company
*
Type "Self" if you own your home.
Landlord/Mortgage Company Phone Number
*
Type "N/A" if you own your home.
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Previous Residence Information
Previous Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Move In Date
*
-
Month
-
Day
Year
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Move Out Date
*
-
Month
-
Day
Year
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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
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Income Information
Where Do You Work?(If not employed, 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.
Phone Number
*
-
Area Code
Phone Number
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
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Personal References
At least 2 should be relatives with separate addresses.
Reference 1 Name
*
First Name
Last Name
Reference 1 Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Reference 1 Phone Number
*
-
Area Code
Phone Number
Reference 1 Relationship
*
eg. "Brother," "Step-Father," "Friend," "Cousin"
Reference 2 Name
*
First Name
Last Name
Reference 2 Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Reference 2 Phone Number
*
-
Area Code
Phone Number
Reference 2 Relationship
*
eg. "Brother," "Step-Father," "Friend," "Cousin"
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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.
Have you rent-to-owned anywhere else before?
*
Yes
No
If so, where?
What merchandise/property are you interested in?
*
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Co-Signer Information
Do you have a co-signer?
*
Yes
No
Name
First Name
Last Name
Birthdate
-
Month
-
Day
Year
Date Picker Icon
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
Primary Phone Number
-
Area Code
Phone Number
E-mail
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
Phone Number
-
Area Code
Phone Number
How long have you been with your current employment?
Leave blank ONLY if you receive government benefits
How Often
How often you receive a paycheck/government award
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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
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File 2
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File 3
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File 4
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File 5
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File 6
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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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