Tenancy Application Form - Harrison Parker Real Estate (Page 3 of 4) in pdf

Shop G26, 1 Greenvale Drive

Greenvale VIC 3059

Harrisonparker Real Estate

Ph: (03) 9333 5600

TENANCYAPPLICATION FORM

.au

PROPERTY DETAILS—

Proposed Property:

Post Code:

Rent Per Week: $

Bond Amount: $

Tenancy to Commence: ___/___/_______

Length of Tenancy:

Years

Months

How many tenants will occupy the property?: Adults

Children

Ages

Pets: Yes/No (circle) Types:

Reg? Y/N Breed/s:

Ages:

Inside/outside

(circle)

Will you be applying for assistance from Ministry of Housing? YES / NO (circle)

Inspected Property YES / NO (circle)

FIRST APPLICANT

SECOND APPLICANT AND/OR PARTNER

Family/Last Name:

Date of Birth : ___/___/_____ Drivers Lic #:

Expiry Date: ___/___/______ License State:

State:

Passport No:

Passport country:

Passport No :

Passport country:

Pension No:

Type:

Pension No:

Type:

(if applicable)

Phone:

Mob Phone:

Phone:

Mob Phone:

E-Mail:

Current Rental History - Applicant 1

Current Rental History - Applicant 2

Current Address:

Post Code:

How long at Current Address?:

Years

Months

How long at Current Address?:

Years

Months

Reason for Leaving:

Rent: $

Reason for Leaving:

Rent: $

Landlord/Agent?:

Ph:

Landlord/Agent?:

Ph:

Bond Refunded:

Y/N If not why?

Bond Refunded:

Y/N If not why?

Previous Rental History - Applicant 1

Previous Rental History - Applicant 2

Post Code:

Length at previous Address?:

Years

Months

Length at previous Address?:

Years

Months

Reason for Leaving:

Rent: $

Reason for Leaving:

Rent: $

Landlord/Agent:

Ph:

Landlord/Agent:

Ph:

Bond Refunded:

If not why?

Bond Refunded:

If not why?

FREE UTILITY CONNECTIONS

P: 1300 854 4 78

Please tick utilities as required

F: 1300 854 479

Electricity

Gas

Water

Phone

Internet

Pay TV

A FREE utility connection service

.au

Once we have received this application we will call you to confirm your details

By signing this application, I consent: to the disclosure of information on this form to myconnect ABN 34 121 892 331 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. Myconnect will make all

reasonable efforts to contact you within 24 hours of the nearest working day on receipt of this Application to confirm your details and explain the details of the services offered.

Signature

Date

Tenancy Application Form - Harrison Parker Real Estate Page 3

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