Gemstone Holdings, LLC

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: ______

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: ______