APPLICATION & CONTACT

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Action Rent To Own in Wichita, KS can be reached by phone, email or using the form to the left. Use the form below to fill out an application.
Action Rent To Own

Store Hours:

Sunday
Closed
Mon - Fri
-
Saturday
-

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Please fill out the below application and submit. We will receive your application through our email. Or download it from the button above.

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CUSTOMER INFORMATION

Landlord
Mortgage Co.

PERSONAL REFERENCES

1

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5

SOURCE OF INCOME

Full Time
Part Time
Temp
WK
2 WKS
MO
Full Time
Part Time
Temp
WK
2 WKS
MO

Have you ever rented from another rental company (yes / no)

RELEASE OF INFORMATION TO ACTION RENT-TO-OWN (PLEASE READ BEFORE SIGNING)

The information I have provided on this form is correct. I authorize confirmation of all information that I have provided. You may contact any person or company that I have listed above and I fully release all parties from all liability for any damages that may result. My (our) signature(s) below indicates that for purpose of confirmation, I (we) have voluntarily waived the protection of all rights to privacy laws. This order may be rejected if any information provided above is found to be false.


I AM APPLYING FOR RENTAL AND AM OVER EIGHTEEN (18) YEARS OF AGE

Customer referral
Newspaper
TV
Direct Mail
Former Customer
Handbill
Other

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