Date: 03/07/2022________
Application Number: ________
Rental Application M
Property Address:2990 Ridgeway Rd
Memphis, TN 38115
from_Ripley Tn_________________________________________
Are you 18 years of age or over? Yes No
SS Number: _xxx-xx-5944___________________
Sex (as identified) _____m____________
Home Phone __731 413 1625______________
Work Phone _7314322262________________________
Have you ever been convicted of any crime? Yes No If yes, explain on back of
application. no
Present Address _148 halliburton st ripley tn
38063___________________________________________ How long at this address _2
years___________
Rent :$1300
Refundable Security Deposit:$700
Reason for moving
__relocated______________________________________________________
Previous Address 239 highland st ripley tn
38063________________________________________________________
How long at this address? _7 years__________
Have you been evicted? Yes No If yes, indicate date ___no_____________________
Other household occupants:
Name _Quinterrian Jelks________________________________
_________________________________ _________________________________
__Sharon Madison______________________________
________________________________
________________________________
When do you plan to move in, please write exact date?__03/22/2022__________________
Do you agree to pay the payment before you move in:_yes_________
If you are ask to make a down payment to secure the house today and
take it off market & for you to take the key from the box, How much
will you be able to pay:_140_________?
Any pets? _yes_________Describe: _K0___________________ Waterbed? Yes No Do you or
any of the prospective occupant smoke? Yes No
Current Employer _medegen medical______________________________ Phone 901 867
2951__________________ How long with this employer? _4.5 years____ Supervisor
_Doyle edwards___________________ Phone _731 432 2232__________ Current gross
income per month _2640____________
Previous employer ___________________________________ Phone ____________ How long
with this employer? _____ Supervisor _________________________ Phone
______________Other sources of income
___________________________________________________
Birth Date 09/16/1978_____________
License Number: 0008361093_______________
Vehicle: Make: _nissan_________ Model _sentra_____________ Year _2016___________
Vehicle plate no: ___________ Is the vehicle registered in Tennessee State? Yes No
If no, please indicate state _tn____________
Personal reference: _Sharon
Madison_______________________________________________________
Address ___5684 Los Gatos Drive APT
1901_________________________________________Phone ___________
Phone 901 770 0700__________ Phone ___________
Emergency Contact Number: ______________ Name __________________________ Address
_____________________________________________ Phone ___________
I declare that the statements above are true and correct. I hereby give
authorization to landlord or landlord’s agent to verify all information provided in
this application. Permission is granted to interview current and previous
landlords, employers, to check criminal record, court records, income, bank
account, and credit information. I understand that providing false, misleading or
incomplete information will result in my application being denied.
Date_03/07/2022___________ Signed__Willie QWuincy
Jelks______________________________________________
Office Use Only Date Received __________ Time Received _________ Date Verification
completed ___________ Denied Yes No
Reason:
NOTE : ALL PAYMENT ARE REFUNDABLE
Thanks and God bless