Rent Per Week
Bond Amount
Term
Commence
[text*num-adults placeholder "Adults"]
YesNo

Applicant 1 - Details

Date of Birth
Drivers Lic #
Exp
State
Passport #
Passport Country
Pension No (If applicable)
Type
Current Address
Post Code
Phone
Mobile
Email

Applicant 2 - Details

Date of Birth
Drivers Lic #
Exp
State
Passport #
Passport Country
Pension No (If applicable)
Type
Current Address
Post Code
Phone
Mobile
Email

Applicant 1 - Current Landlord/Agent Details

Years
Months
Reason for leaving
Landlord/Agent
Landlord/Agent Email
Rent Per Week
Bond Refunded YesNo
If not why?
Previous Res Address

Applicant 2 - Current Landlord/Agent Details

Years
Months
Reason for leaving
Landlord/Agent
Landlord/Agent Email
Rent Per Week
Bond Refunded YesNo
If not why?
Previous Res Address

Applicant 1 - Previous Landlord/Agent Details

Years
Months
Reason for leaving
Landlord/Agent
Landlord/Agent Email
Rent Per Week
Bond Refunded YesNo
If not why?

Applicant 2 - Previous Landlord/Agent Details

Years
Months
Reason for leaving
Landlord/Agent
Landlord/Agent Email
Rent Per Week
Bond Refunded YesNo
If not why?

Applicant 1 - Current Employment

Current Occupation
Nature of your Employment
FULL TIMEPART TIMECASUAL
Current Employer's Name
Employer's Address
Contact Name
Phone
Years
Months
Income

Applicant 2 - Current Employment

Current Occupation
Nature of your Employment
FULL TIMEPART TIMECASUAL
Current Employer's Name
Employer's Address
Contact Name
Phone
Years
Months
Income

Applicant 1 - Previous Employment

Previous Employer
Occupation
Address
Prev Employer's Ph
Time Employed

Applicant 2 - Previous Employment

Previous Employer
Occupation
Address
Prev Employer's Ph
Time Employed

Applicant 1 - If you are Self Employed

Business Name
ABN
Accountant
ABN

Applicant 2 - If you are Self Employed

Business Name
ABN
Accountant
ABN

Applicant 1 - If you are a Student

Institution
Dept
Income Source
Income

Applicant 2 - If you are a Student

Institution
Dept
Income Source
Income

Applicant 1 - Emergency Contact

Applicant 2 - Emergency Contact


Applicant 1 - References

1) Name
Address
Home Phone
Mobile
2) Name
Address
Home Phone
Mobile

Applicant 2 - References

1) Name
Address
Home Phone
Mobile
2) Name
Address
Home Phone
Mobile

PRIVACY STATEMENT & DECLARATION

ARRANGE YOUR MOVING HOME SERVICES

Moving home has never been easier

Connectnow is dedicated to helping you move home more easily. We can connect your utilities including electricity, gas, phone, internet and pay TV to a broad choice of leading providers. We can also organise your disconnections and offer a range of additional services, such as cleaning and food services, removalists and vehicle hire. What’s more, you pay no extra charges as a result of using the connectnow service. We will make all reasonable efforts to contact you within 1 working day of receiving this application to explain the details of the services offered. If we are unable to contact you within this period please call 1300 554 323 to ensure your services can be addressed by the required date.


PRIVACY CONSENT AND TERMS: By signing this form you consent and agree to the following: Connect Now Pty Ltd (ABN 79 097 398 662) (“connectnow”) will collect, use and disclose your personal information to contact you (including electronically) about providing moving, connection and disconnection services and to inform you about products and services offered by its related companies and third party suppliers. These other companies may also use your details to contact you directly about their products and services. See connectnow’s Privacy Policy for further details, including your rights to access and correct the information held about you at connectnow.com.au. Third party service providers (who may transfer your data overseas) may have their own Privacy Policy, which you can request from them. You consent to connectnow continuing to market to you unless you opt out, including by emailing privacy@connectnow.com.au. To the extent permitted by law, connectnow is not responsible or liable for delayed or failed connections or the service providers’ connection charges, which you must pay to them directly. Connectnow may be paid a fee by service providers and may pay a fee to real estate agents relating to services provided to you. If you nominate an alternative contact person on this application, you authorise them to act on your behalf to arrange moving, connection and disconnection services, including accepting third party terms. You warrant that you are authorised to make this application on behalf of all applicants and alternative contact persons listed and that each person has consented and agreed to the handling of their personal information on the same terms as you have.