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Online Reservation Form


Gallina Management, Inc. would be pleased to reserve your apartment home for you at one of our communities.
Simply complete the following form, and your request will be e-mailed to our offices.
One of our leasing consultants will contact you to further discuss your apartment needs and
will help in the selection of your new home. At that time the leasing consultant will assist
you in the completion of an application. Upon receipt of a $100 application deposit
the apartment will be held for you until your move-in date.

Please complete all required fields - labeled with an asterisk*

Property Name* :
Move-In Date:
Reserve an apartment for* :
(name)



Current Street Address:
City:
State:
Zip:
Phone Number* :
E-Mail Address* :
 
Source of Income:



NAME OF PERSONS TO OCCUPY APARTMENT (Applicant should be #1):  
1. 3.  
2. 4.
 
Do you have any pets? Dog Caged Animal  
  Cat Other  
       
Number of Bedrooms Desired: Efficiency View Desired: Courtyard
  Studio   Green Space
  1 Bedroom   City
  2 Bedroom   Not Important
       
Which Floor Would You Prefer: Ground Apartment Style: Loft (two level)
  Second   Ranch (single level)
  Third    
  Fourth    
     
Special Requests/Amenities Desired: Fireplace Whirlpool Tub
  Microwave Oven Ceiling Fan
  Elevator Building Clubhouse
  Pool Exercise Room
  Underground/Garage Parking
  Smoke Free & Pet Free Building
  Other:
Do you have renter's insurance? Yes | No  
* Note: Future residents with waterbeds are required to have renter's insurance.
How did you learn about us?



Applicant's Initials : Today's Date:
   
Additional Comments:
 
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Thank you for your reservation at a quality Gallina Management, Inc. property.
The apartment communities more people like to call home.


You will receive an email message confirming the submission of your application.