Intent to Rent

Please Note: Memphis Tenant Placement is an Equal Opportunity Housing Provider, and Does Not Discriminate Against Any Applicant Regardless of Race, Beliefs, or Religious Background.

Property Address Your Would Like To Rent: Full Name: Phone: Email: City: State: Zip: SSN:   Driver Licence #: State of Issuance: Address: How long have you lived at your current residence? Why are you moving? How many people do you intend to have living in the home? Adults: Children: Please Note: All adults over the age of 18 need to be on the application and pay the application fee. Our application fee is $35 for the first adult and $15 for each additional adult on the application.   Employment Information: Are You Employed? Yes No      If yes, whre: How much do take home weekly? Name of employer? Employer's address? Supervisor Name: Supervisor contact number: May we contact your employer? Yes No   PLEASE GIVE RESIDENTIAL HISTORY (LAST 3 YEARS) Current Address: Apt #: City: State: Zip: Month/Year Moved In: Reason for Leaving: Rent $: Owner/Agent: Phone: Previouse Address (Last 3 Years): Rent $: Owner/Agent: Phone:   PLEASE DESCRIBE YOUR CREDIT HISTORY: Have you declared bankruptcy in the past seven (7) years? Yes No Have you ever been evicted from a rental residence? Yes No Have you had two or more late rental payments in the past year? Yes No Have you ever willfully or intentionally refused to pay rent when due? Yes No Do you have any convictions? Yes No Do you have any evictions? Yes No Do you have any judgments? Yes No NOTE: Having these will not necessarily disqualify you from renting a home with us.   Vehicle Information: Make / Model: Year: License Plate: State:   Tenant Disclosure I certify that the information I have presented here, to the best of my knowledge, is fully true and accurate, and I understand that any falsification of information in this application is IMMEDIATE GROUNDS FOR DISQUALIFICATION. I further understand that my application fee is NONREFUNDABLE. However, my deposit is FULLY REFUNDABLE should I not be approved for a home from Memphis Tenant Placement.   Digital Signature: Credit Card Information: Card Type: American Express Discover Master Card Visa Card Number: Experation Date: 3-Digit Security Number: