G.T. Inc., a Wyoming Corporation
Gemstone Holdings, LLC.
1267 North 15th Street ~ Suite 101
Laramie, WY ~ 82072
(307) 745-3312 Phone ~ (307) 745-8617 Fax
Rental Application
* Hit tab to move to the next line or highlight the next line to fill it in *
PERSONAL INFORMATION
Applicant’s Full Name: ______
Telephone: ( ) ______Email: ______
Date of Birth: ______Social Security Number: ______
Driver’s License #: ______State: ______Expires: ______
APARTMENT INFORMATION
Desired Date of Occupancy: ______Desired Property: ______
Roommate’s Name: ______
ADDRESS HISTORY
Current Address: ______
City: ______State: ______Zip Code: ______
Dates - From: ______To: ______
Current Landlord: ______Landlord’s Telephone: (___) ______
Monthly Payments: ______Reason for Moving: ______
Previous Address: ______
City: ______State: ______Zip Code: ______
Dates - From: ______To: ______
Previous Landlord: ______Landlord’s Telephone: (___) ______
Monthly Payments: ______Reason for Moving: ______
EMPLOYMENT INFORMATION
Your Status:[ ] Employed Full-Time
[ ] Employed Part-time
[ ] Student
[ ] Not Employed
[ ] Retired
Current Employer (or most recent): ______Telephone: (___) ______
Address: ______
Dates Employed - From: ______To: ______Position: ______
Supervisor: ______Gross Monthly Income: ______
Previous Employer: ______Telephone: (___) ______
Address: ______
Dates Employed - From: ______To: ______Position: ______
Supervisor: ______Gross Monthly Income: ______
PERSONAL REFERENCES
Name: ______Telephone: (___) ______
Address: ______Relationship: ______
Name: ______Telephone: (___) ______
Address: ______Relationship: ______
INCOME SOURCE
Source of Income (employer, parents, etc.): ______
Amount of Income Received: ______
If there are other sources of income you would like us to consider, please list below. You do NOT have to reveal child support, alimony, or spouse’s income unless you want us to consider it in your application.
Amount: ______Source: ______Telephone or Verification: ______
Amount: ______Source: ______Telephone or Verification: ______
OTHER INFORMATION
Total number of vehicles: ______
Make/Model: ______Year: ______Color: ______Plate Number/State: ______
Make Model: ______Year: ______Color: ______Plate Number/State: ______
HAVE YOU EVER:
Been sued for non-payment of rent? Y[ ] N[ ] If yes, explain: ______
Been evicted or asked to move out? Y[ ] N[ ] If yes, explain: ______
Broken a rental agreement or lease? Y[ ] N[ ] If yes, explain: ______
Been sued for damage to rental property? Y[ ] N[ ] If yes, explain: ______
Been convicted of a felony? Y[ ] N[ ] If yes, explain: ______
Been registered as a sex offender? Y[ ] N[ ] If yes, explain: ______
In case of personal emergency, notify: ______
Address: ______Relationship: ______
Home Telephone: (___) ______Work Telephone: (___) ______
There is a $40.00 non-refundable application fee per applicant.
Applicant / Guarantor hereby further authorize Landlord to use any consumer reporting agency, credit bureau or other investigative agencies employed by such, to investigate the references herein listed or statements of other data obtained from me/us or any other person pertaining to my/our employment history, prior credit tendencies, character, general reputation, personal characteristics, and mode of living, to obtain a consumer report and such other credit information which may result thereby, and to disclose and furnish such information to the owner’s agent listed above in support of this application. I/We have been advised that I/we have the right, under Section 606B of the Fair Credit Reporting Act, to make a written request, within reasonable time, for a complete and accurate disclosure of the nature and scope of this investigation. I/We warrant and agree to the terms and conditions which I/we have read and understand.
I HEREBY MAKE APPLICATION FOR RENTAL AGREEMENT/LEASE AND CERTIFY THAT THIS INFORMATION IS CORRECT, AUTHORIZE YOU TO CONTACT PREVIOUS LANDLORD(S), EMPLOYERS, AND PERSONAL REFERENCES THAT I HAVE GIVEN IN THIS APPLICATION. I HEREBY RELEASE YOU FROM ANY LIABILITY WHEN CONTACTING OR PURSUING ANY INFORMATION CONTAINED HEREIN AND SHALL HOLD YOU HARMLESS OF THE SAME.
Signature of Applicant: ______Date: ______