Address Applying For

2245 Crescent Avenue

Gailyn on Laurel

Sharon Road

Date Needed *

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DD

YYYY

Applicant's Name *

First Name

Last Name

Applicant's Birthdate *

MM

DD

YYYY

Contact Phone #

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Work Phone #

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Supervisor Phone

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Have you declared bankruptcy in the last seven (7) years *

Yes

No

Have you ever been evicted from a rental residence? *

Yes

No

Have you had two or more late rental payments in the last year? *

Yes

No

Current Landlord / Rental Agent Phone *

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Current Landlord / Rental Agent Fax

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Landlord / Rental Agent Phone

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Landlord / Rental Agent Fax

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Application Fee *

Applicant has submitted the sum of $30, a non-refundable payment for an application fee, receipt of which is acknowledged by Management. Such sum is not a rental payment or a payment of administration fee. In the event the application is not approved, this sum will be retained to cover the cost of processing the application as furnished by the applicant. This application must be signed before it will be processed by Management. Any false information will constitute grounds for rejection of this application and grounds for termination of a lease agreement. Failure to pay rent when due will result in eviction proceedings and court costs.

Application fee has been submitted via Check for $30.

I understand my $30 Application Fee is NON-REFUNDABLE.

Legal Identification

Applicant must include copy of Driver's License with Application.

Copy of Driver's License has been submitted via mail.

Copy of Driver's License has been submitted via email.

Copy of Driver's License has been submitted via fax.

Authorize Verification *

I authorize Gailyn Properties to verify my credit, employment, rental history and criminal history report.