Rooming House Agreement Form - Government Of South Australia

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ROOMING HOUSE AGREEMENT
For advice contact Consumer and Business Services on 131 882
PROPRIETOR:
Insert full name/s:
Address:
Postcode:
Contact telephone number:
RESIDENT/S:
Insert full name of resident 1:
Contact telephone number:
Email address:
Insert full name of resident 2:
Contact telephone number:
Email address:
ADDRESS OF PREMISES:
Room:
Address:
TERM OF AGREEMENT:
Starting on:
Ending on (only for fixed agreements):
Fixed term of (eg. 6 or 12 months):
/
/
/
/
RENT:
BOND AMOUNT:
Payment of rent will be made on:
Weekly amount:
Insert day of week rent is due
of each week/fortnight/month
$
$
METHOD OF PAYMENT:
Insert how/where the rent is to be paid:
OTHER CHARGES:
The resident will be required to pay for:
(tick those which are applicable and insert or attach relevant information)
rates and charges for water supply at the rate of $ ..........................per .............….…....
electricity
at the rate of $ ..........................per .............….…....
gas
at the rate of $ ..........................per .............….…....
telephone
at the rate of $ ..........................per .............….…....
meals
at the rate of $ ..........................per .............….…....
other: …………………………………………………...…………………………………………..
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