Rental Application Form

    Rental Property Details

    $
    $

    Preferred payment:

    Have you inspected the property?

    Months

    Do you have pets?

    Utilities Connection

    Please tick Utilities as require:

    By signing this, I/we: Consent to the disclosure of information on this form to Econnex ABN 94 609 377 406 for the purpose of arranging the connection of nominated utility services; consent to Econnex disclosing personal information to utility service providers for the stated purpose and obtaining confirmation of connection; consent to Econnex disclosing confirmation details (including NMI, MIRN, utility provider) to the Real Estate Agent, its employees and Econnex may receive a fee/incentive from a utility provider in relation to the connection of utility services; acknowledge that whilst Econnex 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 Econnex 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. I acknowledge that Econnex record all calls for coaching, quality and compliance purposes.

    Applicant Personal Details

    Rego

    Do you smoke?

    Have you recently applied for community or public housing?

    Has your tenancy ever been terminated by a landlord or agent?

    Are you in debt to another landlord or agent?

    Have any deductions ever been made from your rental bond?

    Contact Details

    Emergency Contact Details

    Current Address

    $
    $

    Previous Address

    $

    Occupation (Current Employer)

    $

    Occupation (Previous Employer)

    $

    Company or Business (if self employed evidence will be required such as Tax or Annual returns, please advise of details)