*SECURE* ONLINE APPLICATION FOR RENTAL OCCUPANCY

Questions? Please Call Homes USA Realty Office @ (763)780-2944 or
Tom @ (763)286-6868 ~ Jason @ (763)286-4277

I would like to rent:
Other (enter address)

Applicant Last Name:
Maiden/Prefix:
First:
Middle:
$45.00 Non-Refundable Application Fee
Select payment type:  
Card Number 
Card Verification Value 
Name on Card 
Expiration Date  
E-mail:
Home Phone:
Cell Phone:
Work Phone:
Work Phone Ext:
Date of Birth://19
Social Security #--
or NS #
Drivers License #
State Issued:
Present Address:
Unit #
City:
State:
Zip:
From:
To:
Rent $
Landlord/Property Name:
Landlord Phone:
Landlord Phone Ext.:
Previous Address:
Unit #
City:
State:
Zip:
From:
To:
Rent $
Landlord/Property Name:
Landlord Phone:
Landlord Phone Ext.:
Present Employer:
Employer Phone:
Employer Phone Ext.:
Position:
From:
To:
Employer Address:
Type:
Supervisor:
Salary:$
Additional Occupant 1:
Additional Occupant 2:
Additional Occupant 3:
Additional Occupant 4:
Additional Occupant 5:
Emergency Contact Name:
Emergency Phone:
Emergency Phone Ext.:
Vehicle Information:
License #
Year:
Make & Model:
Have you ever filed bankruptcy?
If yes, please explain:
Have you ever resided in any other state?
If so, where?
Have you ever been evicted or asked to move?
Have you ever refused to pay rent?
Have you ever been convicted of a crime?
If yes, please explain:
Do you have a legal right to be in the United States?
Yes, I am a US Citizen
Yes, I have valid documentation from the U.S. Dept. of Immigration
      and Naturalization (INS) that allows me to be in the country.
No
Other Comments (second job, other income, etc):

By Digitally Signing and dating below, I authorize Homes USA Realty and TJB Homes, whose address is 9100 Baltimore St NE, Suite #102, Blaine, MN 55449 to investigate my criminal history, residential, employment and income history, bank and credit history for the purpose of housing and/or employment. The source of the information may come from, but is not limited to: credit bureaus; banks and other depository institutions; current and former employers; federal or state records including State Employment Security Agency records; county or state criminal records as follows, or other sources as required. It is understood that a photocopy or facsimile copy of this form will serve as authorization. I understand failure to complete this form completely and truthfully may result in denial and/or forfeiture of deposit. This authorization is for this transaction only and continues in effect for one (1) year unless by state law, in which case the authorization continues in effect for the maximum period, not to exceed one (1) year, allowed by law.


Digital Signature:
(Type Name)
Date: (Month/Day/Year)

By checking this box, I agree to all the terms listed above.

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