HBE Rent-to-Own Computer Application Form

PO Box 111
Berryville, AR 72616
870-423-6223

We ask for references and we may run a credit report or background check.
However, good credit is not the #1 requirement for approval!

Applicant Name & Address First Last
Street Address
City State Zip Code
Date of Birth / MM / DD YYYY
Years at Current Residence
Home Phone # - (###) - ### ####
Cell Phone # - (###) - ### ####
Social Security #
Driver License #
Vehicle Year, Make & Model
Vehicle License Plate #
Armed Services? Yes No
If Armed Service, What Branch?
Number of People Living in Home
Rent or Own Home? Rent Own
If Renting, Landlord Name & Phone #
(If less than 1 year at current residense)
Previous Landlord Name & Phone #
Employer
Years Employed
Address of Employer
Employer Phone # - (###) - ### ####
Employer Contact Name
Applicant's Total Monthly Income $ Round to nearest dollar (IE: 240 not 239.65)
Have you ever declared bankruptcy? Yes No
If Yes on declaring bankruptcy: Date of discharge? / MM / DD YYYY
Have you ever had property forclosed upon? Yes No
If Yes on foreclosure: Date of forclosure? / MM / DD YYYY
Have you ever had something repossessed? Yes No
If Yes on repossession: Date of repossession? / MM / DD YYYY
Co-Applicant Information
Co-Applicant's Name First Last
Co-Applicant's Date of Birth / MM / DD YYYY
Co-Applicant's Phone # - (###) - ### ####
Co-Applicant's Employer
Co-Applicant's Years Employed
Co-Applicant's Address of Employer
Co-Applicant's Employer Phone # - (###) - ### ####
Co-Applicant's Employer Contact Name
Co-Applicant's Total Monthly Income $ Round to nearest dollar (IE: 240 not 239.65)
Co-Applicant in Armed Services? Yes No
If Co-Applicant in Armed Services, What Branch?
References: (3 references from people not living with you)
Reference #1: Name, Address & Phone Number * First Last
Street Address
City State Zip Code
* - (###) - ### ####
Reference #2: Name, Address & Phone Number * First Last
Street Address
City State Zip Code
* - (###) - ### ####
Reference #3: Name, Address & Phone Number * First Last
Street Address
City State Zip Code
* - (###) - ### ####

HBE Rent-to-Own Computer Application Form

HBE Rent-to-Own Computer Application Form

Co-Applicant Information

References: (3 references from people not living with you)