A. AGENT DETAILS
B. PROPERTY DETAILS
1. What is the address of the property you would like to rent?
2. Lease commencement date?
3. Lease term?
4. Property Rental
Per Week OR
5. How many people will normally occupy the property?
#Adults # Children Name/Age___________________________
C. PERSONAL DETAILS _________________________
6. Please give us your details
Date of Birth
Driver’s licence no.
Driver’s licence state
Pension no. (If applicable)
Pension type (if applicable)
7. Please provide your contact details
Home phone no.
Mobile phone no.
Work phone no.
8. What is your current address?
9. Please provide a contact in case of emergency (Next of Kin)
Relationship to you
E. FREE UTILITY CONNECTION SERVICE
To save you time when you’re moving house, UtilityOne can help you arrange
your utility connections:
PHONE ELECTRICITY GAS PAY TV BROADBAND
It’s a FREE service and there’s NO obligation - so just tick this box if you want
UtilityOne to call you and explain how the service works. Then, IF you would
like help arranging your connections, we will confirm the details with you at that
Yes, please contact me!
Utility connection services are provided by:
13 18 19
1300 73 18 19
UtilityOne will use the information in this application to explain the services
offered and to undertake any connection and disconnection services a