Local Tire and Wheel › Tire Shop Near Me | Jonesboro, AR

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Mail:

sales@localtireandwheel.com

Store Hours:

Monday – Friday: 9AM-6PM
Saturday: 9AM-5PM
Sunday: Closed

Message Us

Download Application Here

Application for Lease — Option to Purchase

Applicant(s):

Location *

Name *

Phone Number *

Address *

How long at address *

Do you rent or own *

Name & Number of Landlord

Email(s) *

Driver’s License #(s) *

Date of Birth

City *

ZIP Code *

State(s) *

SSN *

Vehicle:

Make

Model

VIN#

Year

Is your vehicle financed?

If yes, Name & number

What is your payment amount?

Are you interested in tires, wheels, or both?

Employment:

Current Employer

When did you start your current employment? Date

Employer telephone number

Position held

Supervisor Name

Supervisor Title

Weekly / Monthly (select one)

Salary

Other source(s) of income

Previous Employer

Dates of Employment

Telephone Number

References:

Five References Mandatory

Reference 1 Name

Reference 1 Relationship

Reference 1 Address

Reference 1 Telephone number

Reference 2 Name

Reference 2 Relationship

Reference 2 Address

Reference 2 Telephone number

Reference 3 Name

Reference 3 Relationship

Reference 3 Address

Reference 3 Telephone number

Reference 4 Name

Reference 4 Relationship

Reference 4 Address

Reference 4 Telephone number

Reference 5 Name

Reference 5 Relationship

Reference 5 Address

Reference 5 Telephone number

Questions:

Have you ever had a Lease — Option to Purchase Agreement or Rent-to-Own Contract? *

If Yes, did you make all payments due under Agreement/Contract?

Do you currently have a bank account? *

If Yes,

Name of Bank

What type of account

By signing below, you acknowledge that you have understood each question on this Application and the Terms set out below, and that all information contained herein is true and accurate to the best of your knowledge. Further, you represent that Local Tire & Wheel, LLC can rely on the information contained herein to determine your eligibility for a Lease — Option to Purchase Agreement.

Signature of Applicant *

Date *

Signature of Applicant 2

Date 2

Signature of Applicant 3

Date 3