GEMSTONE INVESTMENT MANAGEMENT
an affiliation of Thomsen & Thomsen Inc.
Rental Application
Property Location that you are applying for
*Address
City
State
Contact Information
M
*First Name
Last Name
*Email Address
Phone
Work Phone
Cell Phone
Current Address
Note:  Please provide at least 3 years of residential history.
*Address
City
State
Zip
Resided From
To
Manager/Owner Name
Phone Number
Reason For Leaving
Previous Address
Address
City
State
Zip
Resided From
To
Manager/Owner Name
Phone Number
Reason For Leaving
Previous Address
Address
City
State
Zip
Resided From
To
Manager/Owner Name
Phone Number
Reason For Leaving
Personal Information
*Date of Birth
Month:
Date
Year
Financial Information
Bank Account:
Bank Name
Account Type
Account Number
Balance
Employment Details
Employer Name
Employer Address
City
State
Employer Phone
Supervisor's Name
Title
Position Held
Monthly Pay
Years Worked
Other Information
If Yes, Describe
Have you ever been a defendant in an
unlawful detainer (eviction) lawsuit or
defaulted (failed to perform) any obligation
of a rental agreement or lease?
NO
YES
If Yes, Describe
NO
Have you ever been convicted of a crime?
YES
If Yes, Describe
Have you ever filed suit against a landlord?
NO
YES
If Yes, Describe
NO
Do you have a water bed, an aquarium or
any other water filled furniture?
YES
If Yes, Describe
Are you a smoker?
NO
YES
If Yes, Describe (How many, what kind, size in lbs.)
NO
Do you have pets?
YES
If Yes, Include their name('s) and have them fill out a
separate application
Are you applying with a spouse
or roommate?
NO
YES
Total Number of Occupants:
# of Adults
# of Children under 18 yrs.
                                                               ACKNOWLEDGEMENT

I/We hereby make application to rent.  I am depositing a $(30.00) non-refundable application fee which will be
used to pay for a credit check and any other expenses incurred as necessary to verify information supplied
herewith.  I/We hereby certify that the above information is true and correct to the best of my/our knowledge.  
I/We understand that any false information supplied on this form may cause this application to be disapproved
and the application fee to be forfeited. It is also understood that while approval of this application shall not
constitute a contract to rent the aforementioned premises, I/we agree to sign a rental agreement upon such
approval by (Gemstone Investment Management an affiliate of Thomsen & Thomsen Inc).  Any prepaid deposit
paid by applicant shall be immediately refunded in full if this application is not approved; non-refundable if
application is approved but applicant fails to occupy the premises. I/We hereby give permission to employers,
banks, rental and credit providers, and other agencies to provide all personal information concerning wages and
income, employment, rental and bill paying histories, etc. which might influence the approval of this application to
(Gemstone Investment Management an affiliate of Thomsen & Thomsen Inc).  I/We authorize permission that a
copy of this may be treated as an original.

In accordance with the
U.S. National Electronic Signature Act by typing my name in the fields below, I affirm that I
understand that this legally binds me to every extent as if I/we had signed this application in original ink.
Name:
Date:
SS #