INFORMATION

Name

Email

Phone Number

Date Of Birth

Driver's License Number

Social Security Number

Spouse's Name

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

of Year



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

Alimony or Child Support

Other Income



TOTAL COMBINED INCOME

Monthly Combined Income



CREDIT INFORMATION

Bank Name

Address

Checking Account #

Savings Account #

Name Of Creditor(s), Monthly Payment(s) and Current Balance(s)

Credit Card(s), Monthly Payment(s) and Current Balance(s)



PERSONAL REFERENCE

Name

Address Street, City, State and Zip

Phone Number



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. Please submit form and pay the NON-REFUNDABLE $20 application fee per application using PayPal.

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



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