ATTENTION: If you are in MEMPHIS on a temporary assignment, please let us know before completing application, we have different arrangements for you. CLICK HERE

Personal Information:

Full Name *

Phone *

Email

Date of birth *

Address

Your Address Where You Live Now

State

City

Social Security Number: *

Driver License / State ID *

Employment Information:

Job Title:

Workplace Name, N/A if no job

Length of Employment:

Weekly Income:

Source of Income *

Desired Location

Choose Your House Location *

Choose Your Room # *

Move-in Date *

Emergency Contact

Emergency Full Name *

Emergency Relationship *

Phone Number *

How did you hear about us?

Any Additional Comments or Questions?

Choose All That Apply *

Smoker

I have a car

More than yourself moving in

Move in ASAP

Do you understand that moving in Kim's Room does not create a Landlord Tenant relationship, you are a guest in my home. *

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$ 25

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