Order Form

1. First Name(required)
2. Last Name(required)
3. Address
4. City(required)
5. Zip(required)
6. State(required)
7. Home Phone(required)
8. Cell Phone
9. Email Address
10. Employer(required)
11. Work Number
12. Landlord Phone Number
13. Would you like to receive future offers and information about promotions here at Best Rents Plus?
14. Yes I would like to receive future communications No I would not like to receive future communications
15. If you have questions please feel free to contact a store near you:
16. Groton: 70 Plaza Ct, Groton, Ct 06340 (860) 446-1141
    Norwich: 113 Salem Turnpike, Norwich Ct 06360 (860) 892-5287
    
17. READ STATEMENT BEFORE SIGNING :
19. I Certify that the information supplied by me on this form is true and correct. I authorize verification of the truthfulness of all information contained herein, including contact with any person of firm listed above and fully release all parties from all liability for any damage that may result. Additional information may be required. I have read and understand the statement printed above.