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The information being provided by you is for the purpose of assessing your eligibility as a tenant for The Rent Centre Ltd.

In order for this application to be assessed ALL INFORMATION MUST BE SUPPLIED. THE APPLICATION WILL BE DESTROYED WITHIN 5 WEEKS IF NO TENANCY AGREEMENT IS ENTERED INTO.

Please fax copies of references to 06 345 1527 - these will be required before your application can be processed.

* indicates required information

Surname:

Christian names:

Date of Birth:

year:

Present Address:

Phone Numbers:

Home
Mobile
Work
Email	*

How long have you lived at your present address?

Why are you moving?

What was your previous address?

FLATMATES:

Surname Christian Names

I intend to have adults and children (under18) living with me at the property.

It is a condition of our Tenancy Agreement that rent is paid by Automatic Payment. Can you do this. Yes No

Have you ever been evicted by any landlord or agent? Yes No

Have you ever been refused a property by any landlord or agent? Yes No

Are you currently in debt to any landlord or agent? Yes No

Do you know of any reason that would affect your rental payment? Yes No

Have you ever had deductions made from your bond refund? Yes No

If you have answered YES to any of the above questions, please explain:

I intend to have dogs, cats, and other pets on the property. Note "other" pets
(Not declaring pets is a breach of the Tenancy Agreement.

I am a smoker non-smoker

Housing required: Bedrooms Other

State other requirements

Your preferred suburb is: (Refer to the Area Maps to help you)

My rent range is between and

Long term Short term accommodation is preferred.

Main source of income or current employers name:

Other source of income: Total Weekly Income:

Flatmates source of income: Total Weekly Income:

Name, Address and Phone Number of contact person: (over 18 - not yourself) What is their relationship to you?