Rental Application

Fill out the form below to send us an application for the following property …

OLD STATION

Leased
Bedrooms
2
Bathrooms
1

Leased

983 Old Station Road , Old Station

2 bedroom, neat and tidy home is in a rural setting only 15 mins from Kempsey CBD.

$160 Weekly

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*required fields

 
Have you viewed the property?
yes no 		Lease term required:
6 months 12 months
Title
 First Name*
 Last Name*
Date Of Birth*
 Phone
 Mobile
Email Address*
 
Present Address*
 Time at current address (mm/yyyy)*

 Current rent paid
Name of current Landlord/Agent*
 Landlord/Agent Phone*
 
Previous Address
 Time at previous address (mm/yyyy)

 Was bond refunded?
yes no
Name of previous Landlord/Agent
 Landlord/Agent Phone
 If NO give reason
 
Occupation
 Employer's name*
 Period of employment*
Employer's address
 Employer contact name*
 Employer phone
 
Previous Employer's name
 Previous Employer's address
 Employer contact name
Employer phone
 
Reference 1*
 Relationship*
 Address
Phone*
 
Reference 2
 Relationship
 Address
Phone
 
Country
 Drivers licence no.
 Vehicle reg. no.
Passport no.
Emergency contact name*
 Emergency contact address
 Emergency contact phone*
 
Number of Adults
 Number of Children
 Do you smoke?
yes no 		Do you have pets
yes no
If YES please type breeds
 
Rent in advance
$
(2 weeks or 1 calendar month) 		Bond
$
(4 weeks)
 
I acknowledge receipt of an agency signed copy this form yes no
Signature of Applicant

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