At Rent-A-Center, our customers' interests always come first. And we value your feedback about how we can serve you better. By participating in our online surveys, you'll help us improve our product selection, customer service capabilities, special promotions and much more.

So that we can email you the surveys that best match your interests, please take a few moments to fill in the following information. This information will be kept private at all times.

Remember, you may receive a FREE 30-minute phone card when you sign up and complete your first survey. Hurry, while supplies last. To begin, please provide us with the information below.

First Name:				Last Name:
Address:				Apt/Unit:
City:			State:				Zip:
Phone:				Email:
Your free phone card will be emailed to the address provided above.
I authorize Rent-A-Center to send me surveys via email.
What option best describes you? (select one)
Gold, Platinum or Diamond Rent-A-Center Customer Currently renting with Rent-A-Center Previously rented with Rent-A-Center Never rented with Rent-A-Center Currently renting with another rental company