IonWays, PO Box 17300, Reno NV 89511 Fax
888.580.7040
IonWays Consumer Lease Application
Fax Application To 888.580.7040
PLEASE PRINT CLEARLY, & PROVIDE ALL INFO REQUESTED
(Please allow 2 business days for processing
application. )
Customer Information
First /Middle Initial/Last Name:
Street Address:
City/State/Zip:
How Long At Present Address: Do You Own: or Rent:
Landlord Name: Landlord Phone:
( )
DOB: Home Phone: ( )
Social Security Number: _______- _______ - _______
Email Address:
_________________________________________
Equipment Information
Manufacturer: Emco Tech General Description: IonWays
Water Ionizer
Model: (Check One) Athena($1995.00) ___
Delphi($2495.00) ___
Condition: New
Approximate Equipment Cost: $
Authorization
The
undersigned applies for the Lease indicated in this application.
Everything stated in this application is correct. JR Saver, Inc. may
retain the application whether or not the Lease is approved. JR
Saver, Inc. and its Authorized Affiliates are authorized to check my
credit for the purposes of determining my credit worthiness at the
time of my application or thereafter in connection with the same
transaction or extension of credit and for the further purpose of
reviewing the account, taking collection activity on the account,
and skip tracing. JR Saver, Inc. and its Authorized Affiliates are
authorized to provide history information to others about my credit
standing and your credit experience with me, including but not
limited to credit bureaus, other companies, outside collection
agencies and outside attorneys.
DATE_______________________
SIGNATURE______________________________________________
PRINT NAME
_____________________________________________
