Welcome to Rothmans Real Estate - Rental Application

Head Office:
662 Chapel St
South Yarra VIC 3141

Telephone: 9826 6555
Facsimile: 9826 8844

Address for Correspondence:
PO Box 6034
South Yarra VIC 3141

PROPERTY DETAILS:
Property Address:

Number of Persons:		Adults:	Children:	Pets:
Weekly Rental:	$ Deposit: $

Length of Lease: Commencement Date:	6 Months 12 Months

Surname:	Name:

Phone:	Date of Birth:

Email Address:

Drivers Licence No:

Reg No:

Present Address:

Weekly Rental:	$ How long:

Current Landlord/Agent:	Phone:

Reason for Leaving:

Previous Address:

Present Employer:

Employer Phone:

Occupation:

How Long with Employer	Income:

REFERENCES:
Business 1:	Phone:

Business 2:	Phone:

Next of Kin:	Phone: