Grand Rapids Order Form

Orderform

We are here to help, Your Grand Rapids Store Manager is Kelvin Richardson

No Credit Check - No Deposit - Free Delivery and Installation - Full Parts and Labor Warranty

Contact and Delivery Information

First Name*

Last Name*

E-mail:*

Date of Birth*

Mobile Phone #

Home Address*

Apt #

City*

State*

Zip Code*

Residency Information

Residency*

Length of Time at Address*

Address Match License*

Monthly Payment*

Landlord or Contact Person*

Phone Number*

Income Information

Employer or Source if Income*

Employers Phone*

How Long There?*

Personal References

Name*

Phone*

Relationship*

Name*

Phone*

Relationship*

Name*

Phone*

Relationship*

Product Interested In

By providing your information, you authorize Continental Rental to verify its accuracy. You also consent to receiving calls and text messages related to your account, which may be delivered by either a person or an automated system. These messages may include important account updates such as due dates, transaction details, or service information.

I agree