Rental Application Form (Page 4 of 4) in pdf

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ONE CALL WILL SAVE YOU TIME AND

We are Australia’s No. 1 Moving Services Company. Over the last 10 years, we have helped more than 1 million people

FREE SERVICE

DIRECT CONNECT PROVIDES A

THAT TAKES THE HASSLE OUT OF MOVING.

move house and we would love to help you too!

Simply complete the form below, select the services you would like organised and return this form to your Agent.

With just one call, our free, no - obligation service can help you connect all your services from the moment you move in, so

Direct Connect will then contact you to confirm your details and service request.

you can focus on enjoying your new home.

connect

SERVICES WE

Please tick this box if you would like Direct Connect to contact you in relation to any of the above utilities and

other services.

TO GET CONNECTED ASK YOUR LOCAL REAL ESTATE AGENT TO SEND US YOUR DETAILS

PERSONAL DETAILS

Call us on 1300 664 715 or visit .au

Title

Given Name

Other

Surname

Date of Birth

Mobile phone

Home phone

Work phone

Email Address

ADDRESS DETAILS

New address connection details - Address you are moving to

Connection date (if known)

We guarantee that when you connect with one of our market leading electricity and gas suppliers, your

services will be connected on the day you move in. Please refer to Direct Connect’s Terms & Conditions

for further information.

Once Direct Connect has received this application Direct Connect will call you to confirm your details. Direct Connect will make all reasonable efforts to contact you within

24 hours of the nearest working day on receipt of this application to confirm your information and explain the details of the services offered. Direct Connect is a one stop

connection service. Direct Connect’s services are free. However, the relevant service providers may charge you a standard connection fee as well as ongoing service

charges.

DECLARATION AND EXECUTION: By signing this application, you:

1. Acknowledge and accept Direct Connect’s Terms and Conditions (which are included with this application).

2. Invite Direct Connect to contact you by any means (including by telephone or SMS even if the Customer’s telephone number is on the Do Not Call Register) in order

to provide Direct Connect’s services to you, to enter into negotiations with you relating to the supply of relevant services as agent for the service providers, and to

market or promote any of the services listed above. This consent will continue for a period of 1 year from the date the Customer enters into the Agreement.

3. Consent to Direct Connect using the information provided by you in this application to arrange for the nominated services, including by providing that information to

service providers for this purpose. Where service providers are engaged by you, they may use this information to connect, supply and charge you for their services.

4. Authorise Direct Connect to obtain the National Metering Identifier and / or the Meter Installation Reference Number for the premises you are moving to.

5. Agree that, except to the extent provided in the Terms and Conditions, Direct Connect has no responsibility to you for the connection or supply (or the failure to

connect or supply) any of the services.

6. Acknowledge that Direct Connect may receive a fee from service providers, part of which may be paid to the real estate agent or to another person, and that you are

not entitled to any part of any such fee.

By signing this application form, I warrant that I am authorised to make this application and to provide the invitations, consents, acknowledgements, authorisations

and other undertakings set out in this application on behalf of all applicants listed on this application.

Havig & Jackson

Signature

698 Sandgate Road, Clayfield QLD 4011

Ph: (07) 3326 8444 Fax: 07 3262 9259

Web:

Date

Submit by Email

Email: .au

Direct Connect Australia Pty Ltd

ABN 20 110 316 973

15 Shierlaw Avenue, Canterbury, VIC 3126