Property Address

Suburb

Rent per week

Bond

Full Name:

Your Email

After Hours Phone

Business Hours Phone

Mobile Phone

Date of Birth

Please indicate who else will be residing with you

Person one

Name

Relationship

Age range

Person two

Name

Relationship

Age range

Person three

Name

Relationship

Age range

Do any of you smoke?
Yes
No

References

Your current address

Your previous address

Agent Details (if rental)

Company Name

Contact Person

Phone Number

Second Agent Details (if rental)

Company Name

Contact Person

Phone Number

Have you ever owned a home?
Yes
No

Employment

Your Occupation

Currently Employed With

Length of current employment

General Information

What type of accommodation do you require? (e.g. House, flat? No of bedrooms? Garage? etc)

Rental range (weekly)

Do you have pets?
Yes
No

Drivers License Number

Drivers License State

Closest relative not living with you

Phone number

Personal Reference

Additional comments

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 incurred in undertaking collection action to recover his/her losses.
Yes
No