Rental Application

FICO must be a minimum of 620 in determining eligibility.
Gateway Realty reserves the right to deny your application for any reason not prohibited by law.
Fields indicated with an asterisk (*) are required.

First Name*

Last Name*

Email*

Phone Number*

Date Of Birth*

Driver's License Number*

Social Security Number*

Spouse's Name

Spouse's Email

Spouse's Date Of Birth

Spouse's Driver's License Number

Spouse's Social Security Number

Others Who Will Occupy Property and Their Ages

PRESENT ADDRESS

Address (Street)*

City*

State*

Zip*

Rent Amount*

Number of Years*

LANDLORD INFORMATION

Name*

Address (Street)*

City*

State*

Zip*

Phone Number*

Email*

PREVIOUS ADDRESS

Address (Street)*

City*

State*

Zip*

Rent Amount*

Number of Years*

LANDLORD INFORMATION

Name*

Address (Street)*

City*

State*

Zip*

Phone Number*

EMPLOYER

Company*

Address (Street)*

City*

State*

Zip*

Phone Number*

Job Title*

Salary*

Years*

PREVIOUS EMPLOYER

Company*

Address (Street)*

City*

State*

Zip*

Phone Number*

Job Title*

Salary*

Years*

SPOUSE'S EMPLOYER

Company

Address (Street)

City

State

Zip

Phone Number

Job Title

Salary

Years

OTHER INCOME

Social Security, Pension, Alimony, Retirement, Child Support, Etc.

TOTAL COMBINED INCOME

Monthly Combined Income*

CREDIT INFORMATION

Bank Name*

Bank Address*

PERSONAL INFORMATION

Nearest Relative*

Relation*

Phone Number*

Address (Street)*

City*

State*

Zip*

PETS

Do you have a pet?*

Pet Type

Inside or Outside

CRIMINAL HISTORY

Have You Ever Been Convicted Of A Felony?*

This document has been electronically signed and by checking this box we are giving Gateway Realty of North Platte permission to contact the above references.

Gateway Realty of North Platte, Inc.
111 Halligan Drive
North Platte, NE 69101

Signature*

Signature

Please submit form and pay the NON-REFUNDABLE $20 application fee per adult applicant using the "Add to Cart" button below. (You do not need a PayPal account.)