Product inquiry for

Do you own or rent the property your building will be delivered to?

Own
Rent

Customer Name

Customer Phone Number

Customer Email Address

Customer Home Address

Address Line 1

Address Line 2

City

Province

Postal Code

Customer Drivers License Number

Is delivery address the same as your home address?

Yes
No

Delivery Address

Address Line 1

Address Line 2

City

Province

Postal Code

Employer Name

Employer Address

Address Line 1

Address Line 2

City

Province

Postal Code

Do you have a landlord?

Yes
No

Landlord Name

Landlord Address

Address Line 1

Address Line 2

City

Province

Postal Code

Required Reference #1 Name

Required Reference #1 Phone Number

Required Reference #2 Name

Required Reference #2 Phone Number

Will you have a co-renter?

Yes
No

Co-Renter Name

First

Last

Co-Renter Address

Address Line 1

Address Line 2

City

Province

Postal Code

Co-Renter Drivers License Number

Co- Renter Employer Name

Co-Renter Employer Address

Address Line 1

Address Line 2

City

Province

Postal Code

I agree that by submitting this application, I authorize and give this dealership my consent to submit my information to Premier Portable Buildings. This information is not reported to any credit reporting agency.

I consent.

RTO Direct : Secure Rent-To-Own Form

Premier Buildings of Alberta

Monday - Friday	9:00 AM — 5:00 PM
Saturday - Sunday	Closed