Rent Per Week Bond Amount Term Commence How many tenants will occupy the property? Pets 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 How long at current address? 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 How long at current address? 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 How long at previous address? 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 How long at previous address? 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 Employment 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 Employment 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 [email protected]. 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. Yes, I accept the Terms. Please call me to connect my new home services.
