Carlton Real Estate Application Form Page 2
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1
2Rental Application
Carlton Real Estate P/L
Licenced Real Estate & Business Agents
Auctioneers & Property Managers
NICK VELISSARIS
RENTAL MANAGER
704 Nicholson Street
Tel: (03) 9486 1722
NORTH FITROY
Fax: (03) 9489 1722
Email:
Mobile 0414 334 179
I/WE AGREE TO PAY:
RENT PER CALENDER MONTH: $
SECURITY BOND: $
PROPERTY APPLIED FOR:
APPLICANTS FULL NAME:
PRESENT ADDRESS:
TELEPHONE NUMBER:
DATE OF BIRTH:
OCCUPATION:
HOW LONG EMPLOYED THERE:
EMPLOYERS NAME:
INCOME PER WEEK: $
EMPLOYERS ADDRESS:
TELEPHONE:
NUMBER OF PEOPLE TO RESIDE AT APPLIED PREMISES – ADULTS:
CHILDREN:
NEXT OF KIN:
HOW RELATED TO YOU:
ADDRESS:
TELEPHONE:
TERM OF LEASE:
DRIVERS LICENCE NO:
COMMENCEMENT DATE OF LEASE:
GUARANTOR (IF REQUIRED):
REFERENCES IF YOU HAVE RENTEND IN THE PAST 3 – 4 YEARS
PLEASE ATTACH PHOTO I.D. TO
THIS FORM – DRIVERS
LICENCE/PASSPORT
1. AGENT/LANDLORD:
TELEPHONE:
RENTED PROPERTY ADDRESS:
1. AGENT/LANDLORD:
TELEPHONE:
RENTED PROPERTY ADDRESS:
IF NEVER RENTED
PREVIOUSLY – REASON?
DO YOU HAVE ANY ANIMAL PET/DOG.CAT OR BIRD
YES/NO
BUSINESS REFERENCES (EXCLUDING FAMILY):
1:
TELEPHONE
2:
TELEPHONE
APPLICANT’S SIGNATURE:
DATE:
AGENT OR LANDLORDS SIGNATURE:
DATE:
Utility Connection Service
A FREE utility connection service.
Please tick here, and myconnect will call you to help connect your Electricity, Gas, Water, Telephone
and Internet services.
I would like to use myconnect to assist with the connection of utilities at my new property.
If this section is complete, I/we:
consent to the disclosure of information on this form to myconnect ABN 34121 892 331 for the purpose of arranging the connection of nominated utility services; consent to myconnect disclosing
personal information to utility service providers for the stated purpose and obtaining confirmation of connection; consent to myconnect disclosing confirmation details (including NMI, MIRN, utility
provider) to the Real Estate Agent; acknowledge the Real Estate Agent, its employees and myconnect may receive a fee/incentive from a utility provider in relation to the connection of utility
services; acknowledge that whilst myconnect is a free service, a standard connection fee and/or deposit may be required by various utility providers; acknowledge that, to the extent permitted by
law, the Real Estate Agent, its employees and myconnect shall not be liable for any loss or damage (including consequential loss and loss of profits) to me/us or any other person or any property
as a result of the provision of services or any act or omission by the utility provider or for any loss caused by or in connection with any delay in connection or provision of, or failure to connect or
provide the nominated utilities.
Phone : 1300 854 478 Fax : 1300 854 479
Signature
/
/
.au
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