FALCON STORAGE – RENTAL APPLICATION
Please Fax Completed Application to 512-233-2765 or email to billing@falconstorage.com Questions? Please call 512-231-9603. GENERAL ITEMS
Customer Name _________________________ Address _______________________________ City/State/Zip ________________________ Home Phone # __________________________ Work Phone # __________________________ Cell Phone # __________________________ Fax # _________________________________
Driver’s License # ____________________ Driver’s License State ________________ Social Security # _____________________ email _________________________________
Have you ever filed bankruptcy? ( Y / N )
METHOD OF PAYMENT (Please check only one)
Visa / MC __ ? Amex Discover __ ? __ ?
Credit Card # _________________________ Expiration Date _______________________ CVC (3 or 4 digit code) _______________ Billing Address: _______________________ City/State/Zip
OR
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Check __ ?
Bank Name _____________________________ Bank Address __________________________ Bank City/State/Zip ___________________ Account # _____________________________ Bank Phone ____________________________
Check payments require a deposit equal to the 28-Day Rental Period. First payment including first month, delivery, pickup, and deposit (if applicable) is due at the time of delivery.
SIGNATURE
By signing below I attest that the information provided is accurate and complete, and I authorize Falcon Storage to check my credit, financial and banking history. I accept that invoices are due upon receipt. I also understand and authorize all dishonored checks plus a processing fee to be electronically debited from my checking account. If I elect to pay by credit card, I authorize Falcon Storage to automatically debit the rental charges every billing period. Furthermore, I understand that I am responsible for any damage done to the equipment during the rental period.
Customer Signature ____________________________________ Print Name
Date ________________________________________
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