Rent to Own

Customer Application
Date:  /   /  Time: How Found:
Title: First Name: Surname:
Address: ( years / months ):
Suburb:    City:    State:     Post Code:
Phones: Home:     Work:     Mobile:     Email: 

 
Additional Information

Landlord:     
Previous Address:     
Licence # / Pension #:         Expiry Date:  
Date Of Birth:       /   / 
Occupation:     
Employer Details:     
Permission To
Do Credit Check: 		   Yes No

 
Rental Information
Appliance(s):     
Rental Type      Rent    Rent to Own
Monthly Payment:     $
Payment Details:      Direct Debit (1st or 3rd Friday/Both)
     Centrelink (Fortnightly)
     CTB Deposit Book
Damage Loss Reduction:     $
Payment Amount On Delivery:     $
Date and Time Required:     Date:  /   /       Time: 

 
 APPROVED

 
 DECLINED
Reference(s):  1.    Phone: 
 
2.    Phone: