Number of Occupants
PREVIOUS TENANCY DETAILS
EMERGENCY CONTACT DETAILS
CURRENT TENANCY DETAILS
IF SELF EMPLOYED PLEASE COMPLETE
CURRENT EMPLOYMENT DETAILS
PREVIOUS EMPLOYMENT DETAILS
PERSONAL REFERENCE 1
PERSONAL REFERENCE 2
Provide 100 points of identification photocopied and attached to this application.
ADDITIONAL DOCUMENTS IF NOT INCLUDED IN FULL ABOVE
- 3 MONTHS PAYSLIPS
- 3 MONTHS BANK STATEMENTS
- TENANCY LEDGER
This is a free service that connects all your services with ACN and their partners. By signing below, you agree to MavKho Trade Services connecting the services you have requested through ACN and their partners on your behalf online at http://www.mavkho.acndirect.com once we have received this application we may call you to confirm your details. Marker Realty/ACN will make all reasonable efforts to contact you within 48 hours of the nearest working day on receipt of this Application and may call to confirm the information on this Application and explain the details of the services offered.
Please tick services as required
ElectricityGasHome PhoneInternet ElectricityWaterNBN (IF Application)
DECLARATIONS AND EXECUTION
By signing this application, I/we: consent to MARKER REALTY and their ACN IBO agents arranging for the connection and disconnection of the nominated utility services and to providing information contained in this application to utility providers for this purpose; acknowledge having been provided with terms and Conditions of Supply of ACN IBO and their agents and having read and understood them together with the Privacy Collection Notice set out below; declare that all the information contained in this application is true and correct and given of their own free will; expressly authorise MARKER REALTY to provide any information disclosed in this Application to a supplier or potential supplier of the Service in accordance with the Privacy Collection Notice and to obtain any information necessary in relation to the Services; consent to MARKER REALTY contacting me by telephone or by SMS in relation to the marketing or promotion of all of the services listed under the heading “Utility Connections” above even if we/I have not applied for the connection of those services in this application. This consent will continue [for a period of 1 year from the date of our/my execution of this Application/until  days after we/I disconnect the last of the services in respect of which this Application is made]; acknowledge that this consent will permit MARKER REALTY to contact us/me even if the telephone numbers listed on this application form are listed on the Do Not Call Register; understand that under the requirements of the Privacy Act 1988, MARKER REALTY will ensure that all personal information obtained about me/us will be appropriately collected, used, disclosed and transferred and will be stored safely and protected against loss, unauthorised access, use, modification or disclosure and any other misuse; authorise the obtaining of a National Metering Identifier (NMI) for my residential address to obtain supply details; consent to MARKER REALTY disclosing my/our details to utility providers (including my/our NMI and telephone number); declare and undertake to be solely responsible for all amounts payable in relation to the connections and/or supply of the Services and hereby indemnify MARKER REALTY its officers, servants and agents and hold them indemnified against any charges whatsoever in respect of the Services; acknowledge that, to the extent permitted by law, MARKER REALTY shall not be liable for any loss or damage (including consequential loss and loss of profits) to me/us or any other person or any property as a result of the provision of the services or any act or omission by the utility provider or for any loss caused by or in connection with any delay in connection, disconnection or provision of, or failure to connect or disconnect or provide, the nominated utilities; acknowledge that whilst MARKER REALTY are providing a free service I/we may be required to pay standard connection fees or deposits required by various utility providers; acknowledge that the Services will be provided according to the applicable regulations and that the time frames and terms and conditions of the nominated utility providers bind me/us and that after hours connections may incur additional service fees from utility providers acknowledge that the real estate agent listed on this application form may receive a benefit from ACN in connection with the provision of the service being provided to me/us by MARKER REALTY; and acknowledge the entitlement of ACN and its associates, agents and contractors, to receive a fee or remuneration from the utility provider and that such fee or remuneration will not be refunded to me as a rebate in connection with the provision of the utility connection services. By signing this application form, I warrant that I am authorised to make this application and to provide the consents, acknowledgements, authorisations and other undertakings set out in this application form on behalf of all applicants listed in this application form.
I hereby offer to rent the property from the owner under a lease to be prepared by the Agent. Should this application be accepted by the landlord I agree to enter Into a Residential Tenancy Agreement?
I acknowledge that this application is subject to the approval of the owner/landlord. I declare that all Information contained in this application (including the reverse side) is true and correct and given of my own free will. I declare that I have inspected the premises and am not bankrupt. I authorise the Agent to obtain personal Information from:
(a) The owner or the Agent of my current or previous residence;
(b) My personal referees and employer/s;
(c) Any record listing or database of defaults by tenants;
If I default under a rental agreement, I agree that the Agent may disclose details of any such default to a tenancy default database, and to agents/landlords of properties I may apply for in the future. I am aware that the Agent will use and disclose my personal information in order to:
(a) Communicate with the owner and select a tenant
(b) Prepare lease/tenancy documents
(c) Allow tradespeople or equivalent organisations to contact me
(d) lodge/claim/transfer to/from The Residential Tenancies Bond Authority
(e) Refer to Tribunals/Courts & Statutory Authorities (where applicable)
(f) Refer to collection agents/lawyers (where applicable)
(g) Complete a credit check with NTD (National Tenancies Database) Phone: 1300 563 826 email: info@NTD.com.au
(h) Transfer water account details into my name
I am aware that if information is not provided or I do not consent to the uses to which personal information is put. The Agent cannot provide me with the lease/tenancy of the premises. I am aware that I may access personal information on the contact details above.
I agree to the declarations and terms outlined in this agreement.
Please send any supporting documents to firstname.lastname@example.org.