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    • The Dixie Agency Of Memphis, LLC
     5395 Fox Plaza Drive, Suite 100
    Memphis, TN 38115
    Phone : 901-692-9200
    Fax : 901-692-9201


    Ever been evicted or asked to vacate?

    Ever been subject to an FED

    Refused To Pay Rent

    Had your wages garnished

    Had a security deposit not returned

    Broken a lease?

    Been sued for damages to a rental property?

    Sued a landlord or included a landlord in a bankruptcy?

    Declared bankruptcy?

    Been arrested or convicted of a violent or aggravated crime? (or misdemeanors)

    Been arrested or convicted of drug charges or simple possession?

    Been arrested or convicted of harassment or other aggravated crime?

    Been arrested or convicted of a sex crime?

    Been required to register as a sex offender?

    Are you subject to a job transfer?

    Are you subject to a job layoff or work slow-down?

    Do you know of anything that may interrupt your ability to pay rent?

    Is there anything that would keep you from putting utilities in your name?

    Rental Application
    Part (4) of 4

    Thank you for completing this Secure online application. We take your security seriously. Each form is submitted and secured by 128 bit data encryption. At no point is your data exposed to the internet in an unencrypted fashion.

    One of our helpful staff members will be in touch with you shortly regarding this application.

    All Applicants over the age of 18 MUST submit a seperate application

    A $30.00 NON-REFUNDABLE application fee PER ADULT over the age of 18 will be applied

    ALL applicants consent to a credit and background check.


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