Date

Addressrequired

Suburbrequired

Rent per week $required

Rent per week $required

Full Namerequired

Email Addressrequired

Date of Birthrequired

Status

• Single
• Married
• Solo
• Defacto

Your current addressrequired

Home Phonerequired

Work Phone

Mobile Phone

Name

Relationship

Age

Name

Relationship

Age

Name

Relationship

Age

Are you, or any of the above stated, smokers?

• Yes
• No

Previous Address

Your Occupationrequired

Currently employed withrequired

Do you have rental references?

• Yes
• No

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?

• Yes
• No

Drivers Licence Number

Name of next of kin

Contact Ph No

Additional Comments

By pushing the submit button below, 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.