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.

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 and Zip

Rent Amount

Number of Years

LANDLORD INFORMATION

Name

Address Street, City, State and Zip

Phone Number

Email

PREVIOUS ADDRESS

Address Street, City, State and Zip

Rent Amount

Number of Years

LANDLORD INFORMATION

Name

Address Street, City, State and Zip

Phone Number

Rent Amount

Number of Years

EMPLOYER

Company

Address Street, City, State and Zip

Phone Number

Job Title

Salary

Years

PREVIOUS EMPLOYER

Company

Address Street, City, State and Zip

Phone Number

Job Title

Salary

Years

SPOUSE'S EMPLOYER

Company

Address Street, City, State and 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

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.)