Washer/Dryer Rental Application

We currently deliver to apartments in the following areas:
Oklahoma City, Norman, Moore, Edmond, Yukon, MWC/Del City, El Reno, Lawton, and Duncan
Please fill in the information in the form below.  We must have all of the following information in order to process your application.  If you would like to call and give your information over the phone, you may do so by calling 405-692-4800 or toll free at 800-335-3600.  The application will be verified and someone will contact you to set up a date/time for delivery.

Applicant Information:

Full Name
Date of Birth -- mm/dd/yy
Social Security # -- xxx-xx-xxxx
Drivers License #
Employer
Occupation
Work Address
City
State/Province
Zip/Postal Code
Work Phone Ext.

Apartment Information

Apartment Complex
Street Address
Apartment #
Floor
City --OKC metro only
State/Province
Zip/Postal Code
Home Phone
Email Address

Secondary Contact Information (relative not living in the same apartment):

Name
Street Address
Relationship to Applicant
City
State/Province
Zip/Postal Code
Home Phone

What type of equipment would you like to rent?


Apartment Lease Term  (start date, end date):

-- mm/dd/yy        -- mm/dd/yy

Preferred Date for Delivery:

-- mm/dd/yy

Who referred you to Elite Wash?
(if it was your leasing agent, please give his/her name)

You must provide a credit card in order to apply
(if you would like to leave this section blank, you can give the credit card information over the phone at a later time.)

Visa
MasterCard

Card Number (no spaces)


Expiration Date

-- mm/dd/yy

Name as it appears on card


Comments:

After this form is submitted it will be verified and someone will contact you to set up a delivery date.

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Copyright © 2005 Elite Wash, Inc. All rights reserved.
Revised: 03/28/11