Laundry Rental Application

First Name

Last Name

Date of birth

Phone *

Email *

Returning Customer? *

Yes

Do you rent or own your home?

Rent

Own

Address

Street Address

City

State

Country

Postal code

Apartment Number

Is there a Gate code ?

Where will your machines be installed ?

Do you have a pet that sheds ?

Yes

Secondary Contact Name

Secondary Contact: Phone Number

Relationship to Secondary Contact

I consent to my secondary contact being contacted and held accountable for updates payments or machine retrieval if I'm unresponsive

I Consent

Who else lives with you? ( Full names, separated by commas)

If Renting , Landlord/Property Manager name ?

Landlord/Property Manager Phone number ?

Are you currently employed ?

Yes

Current Employer name ?

Employer Phone Number ?

If we can't reach you, I authorize Laundry Rental and its associates to contact my Landlord, Property Manager , and or Employer to assist in retrieving our machines which remain property of Laundry Rental L.L.C.

Yes , I authorize

ID or Driver's License number ?

Upload your ID or Driver's License

Upload Pay Stub or Utility Bill (Optional, but helps you get approved faster)

If you OWN your home please upload a copy of your Home Owners Insurance

Full Name