Date of Birth (MM/DD/YY) Social Security Number Phone Number

Street Address

Email Address

City State Zip Code

Type Own Rent Other Monthly Payment/Rent Amount How Long

Previous Address

City State Zip Code

Type Own Rent Other How Long

Current Employer

Address/Unit

How Long (Years/Months) Salary Frequency Weekly Bi-Weekly Twice Monthly Monthly Annualy

Position/Rank Work Phone

Personal Reference (closest relative not living with you)

Name(First, MI, Last)

Phone Number

City State Zip Code

Second Personal Reference

Name(First, MI, Last)

Phone Number

City State Zip Code

Information About Co-Applicant (if applicable)

Name (First, MI, Last)

Date of Birth (MM/DD/YY) Social Security Number Phone Number

Street Address

City State Zip Code

Type Own Rent Other Monthly Payment/Rent Amount How Long

Previous Address

City State Zip Code

Type Own Rent Other How Long

Current Employer

Address/Unit

How Long (Years/Months) Salary Frequency Weekly Bi-Weekly Twice Monthly Monthly Annualy

Position/Rank Work Phone

Which Rooms for Less location will you be shopping at?

2168 Fort Campbell Blvd, Clarksville TN

141 Old Trenton Road (at Wilma Rudolph Blvd), Clarksville TN

2608 Ft Campbell Blvd, Hopkinsville KY

Salesperson Name (If Applicable)

For faster processing of your application please attach a PDF of your current
end of month LES (military only).