New Customer Rental Application

Please Select the Type of Appliance(s) You Are Applying For*:

Electric Water Heater Gas Water Heater Other Appliances✝

Name*:

Street Address*:

City*:

State*:

ZIP Code*:

Email Address*:

Phone Number*:

Property Owner*: YesNo

I certify that the information furnished on this application is true to the best of my knowledge and belief. Authorization is hereby given to AWHR America's Water Heater Rentals, LLC. and/or any related business entity to contact recognized credit bureaus in order to secure credit information they may have pertaining to my credit paying habits, and further, to verify information furnished on this application. ✝Not available in all markets. Contact us for details.

Thank you for your excellent service in the late afternoon on Friday the 13th.

New Customer Rental Application

AWHR American Water Heater Rental