Email Address
Date of Birth
Status
Single
Married
Solo
Defacto
Please state who else will be residing with you
Name
Relationship
Age
Are you, or any of the above stated, smokers?
Yes No
Your current address
Your Contact phone numbers
Home
Work
Mobile
Previous Address
Your Occupation
Currently employed with
Do you have rental references?
What type of accomodation do you require? (eg. House, Flat? No of Bedrooms? Garage?)
Maximum rent you can afford
$
When do you need a place by?
Have you any pets?
Drivers Licence Number
Name of next of kin
Contact Ph No
I authorise that the above information may be used to carry out a credit check on me. I also agree that should I be in breach of any express or implied provision of the tenancy agreement or any provision of the residential Tenancies Act, that I will pay the Landlord's costs's incurred in undertaking collection action to recover his/her losses.
