Gallina Companies - Apartment, Commercial and Retail Rentals in Madison, Green Bay, Appleton, DePere and many other Wisconsin, Illinois and Florida communities.

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.

Note: Fields marked with an asterisk ( * ) are required.

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.

Applicant's Initials :		Today's Date:

Additional Comments :

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.