Tenancy Application Request
Date 24 May 2013
Property Applying For
Tenancy Start Date
(when could you move in?)		  date picker
Address
Suburb
Rent per week $
Bond $
Your details
Full Name
Email Address
Date of Birth
Please indicate who else will be residing with you
Name
Relationship
Age Range
Name
Relationship
Age Range
Name
Relationship
Age Range
Do any of you smoke? Yes No
Contact Information
Your current address
Business Hours
After Hours
Mobile
Previous Address
Agent Details (if rental)
Agent / Landlord Reference 1
Company Name
Contact Person
Phone Number
Agent / Landlord Reference 2
Company Name
Contact Person
Phone Number
Have you ever owned a home? Yes No
Employment
Your Occupation
Currently employed with
General Information
What type of accomodation do you require?
(eg. House, Flat? No of Bedrooms? Garage?)
Rental Range (weekly)
Do you have any pets? Yes No
Drivers Licence Number
Drivers Licence State
Closest relative not living with you
Address
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
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Queenstown Accommodation Centre, Licensed Agent (REAA 2008)