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Cobden Township
South-West Victoria
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Tenancy Application
General Details
Date
Address
required
Suburb
required
Rent per week $
required
Rent per week $
required
Personal Information
Full Name
required
Email Address
required
Date of Birth
required
Status
Single
Married
Solo
Defacto
Your current address
required
Home Phone
required
Work Phone
Mobile Phone
Please state who else will be residing with you
Name
Relationship
Age
Name
Relationship
Age
Name
Relationship
Age
Are you, or any of the above stated, smokers?
Yes
No
Additional Information
Previous Address
Your Occupation
required
Currently employed with
required
Do you have rental references?
Yes
No
What type of accomodation do you require?
(eg. House, Flat? No of Bedrooms? Garage?)
Maximum rent you can afford $
When do you need a place by?
Have you any pets?
Yes
No
Drivers Licence Number
Name of next of kin
Contact Ph No
Additional Comments
By pushing the submit button below, I authorise that the above information may be used to carry out a credit check on me. I also agree that should I be in breach of any express or implied provision of the tenancy agreement or any provision of the residential Tenancies Act, that I will pay the Landlord's costs's incurred in undertaking collection action to recover his/her losses.
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