Complete the application form and we'll be in touch

Property Details
*Address of property I am applying for
*Intended moving date

Applicants Details
*First Name(s)
*Last Name
*Gender

Please make a selection.
*Phone
Mobile Phone
Email Address
*Date of Birth
*Age
*Drivers Licence or Birth Cert Number
*Drivers Licence 5b Number
Enter N/A if not applicable
*Current Employer
*Position
*Work Phone
*Total weekly income
WINZ ID
 

Current Address
*Current Address
*How long have you lived here
*Current rent amount
*Reason for leaving
*Name of Landlord
*Landlord Contact Number
   

Partner / Spouse Details
First Name(s)
Last Name
Gender

Phone
Mobile Phone
Email Address
Date of Birth
Age
Drivers Licence or Birth Cert
Number
Drivers Licence 5b Number
Enter N/A if not applicable
Current Employer
Position
Work Phone
Total weekly income
WINZ ID
   

Previous Address
*Previous address A value is required.
*How long did you live there
*Previous rent amount
*Reason for leaving
*Name of Landlord
*Landlord Contact Number

Name of two referees (not family or friends)
*1st Referee
*Relationship to applicant
*Phone
*2nd Referee
*Relationship to applicant
*Phone

Relative not living with you
*Name
*Address
*Phone
 

Occupants
*How many occupants will be residing at this property?
   
*1st Occupant Name
*Occupation
*Age
   
2nd Occupant Name
Occupation
Age
3rd Occupant Name
Occupation
Age
   
4th Occupant Name
Occupation
Age

Do you have any pets?

*If so, please list
(eg: 2 cats, 1 dog. Or write NONE)
 

Are any occupants smokers?
*If so, how many?
(Write NONE if no Smokers)
 

Evicted or in Debt
Have you even been evicted or in debt to another landlord or agent *


Please make a selection.

If yes please give details
 

Terms and Conditions

All tenancies are subject to a letting fee (one weeks rent + GST) unless otherwise stated. Each person intending to sign the Tenancy Agreement must complete a separate Application form. This application form collects information about you. Application forms will be retained by Channel Realty Ltd MREINZ (HARCOURTS) for I month. You have the right to see and, if necessary, correct information held. If you enter into a Tenancy Agreement and fail to comply with the terms of that Agreement information will be sent to a Tenant Default Database.

I/we authorise Channel Realty Ltd MREINZ (HARCOURTS) to make independent checks of the information provided in this application including checks with the people I have named as referees and any other Credit Bureau or Tenant Default databases. All information held by Channel Realty Ltd MREINZ (HARCOURTS) is confidential. Failure to supply full and current details may result in non-acceptance of an Application or Termination of a tenancy. A separate form is required for each person who proposes to enter a tenacy agreement.
* I agree to the terms & conditions
You must agree to the terms & conditions