Below is our online Rental Application form. Please fill out your Application in full in order to submit it.

* indicates required fields

Agency Details

Helen Harm Real Estate
53 Fitzroy Street, PO Box 859
Warwick QLD 4370
Phone: (07) 4661 3663
Mobile: 0408 457 496
Email: helen@helenharm.com

PART 1: Rental Property Details

Property Details

Street Address *

Suburb *

State *

Post Code *

Rent *

Rent Period *

Bond *

Tenancy Term *

Fixed Term Agreement

Yes

Periodic Agreement

Yes

Starting On *

Ending On *

PART 2: Applicant Details

Contact Details

First Name *

Last Name *

Date of Birth

Are you applying with anyone else? *

Yes No

Have you been known by any other name(s)? *

Yes No

Work Phone *

Home Phone *

Mobile Phone *

Email *

Driver's Licence/Passport Number *

State *

Expiry Date *

Number Of Vehicles *

Registration Number(s) *

Dependants

Do you have any dependants? *

Yes No

Smoking

Are you or any of the dependants living with you a smoker? *

Yes No

Pets

Do you intend to keep pets at the property? *

Yes No

PART 3: Address History

Current Residential Address

Street Address *

Suburb *

State *

Post Code *

Period Of Occupancy *

Type Of Occupancy *

Rental Owner Other

Previous Residential Address

Street Address *

Suburb *

State *

Post Code *

Period Of Occupancy *

Type Of Occupancy *

Rental Owner Other

PART 4: Employment Details

Are you Employed? *

If no, please provide details of previous employer if any.

Yes No

Occupation *

Net Income (per week) *

Date Commenced (approx) *

Date Terminated Employment (if any)

Employer / Business Name *

Employer / Business Phone *

Employer / Business Email *

Employer / Business Address

Street Address

Suburb

State

Post Code

Centrelink Payments

Are you receiving any regular Centrelink payments? *

Yes No

Are you an overseas student? *

Yes No

PART 5: References

Personal References

Please do not list relatives, another applicant or partners and provide business hours contact numbers.

Referee 1 *

Relationship *

Phone/Mobile *

Referee 1 Address

Street Address

Suburb

State

Post Code

Referee 2 *

Relationship *

Phone/Mobile *

Referee 2 Address

Street Address

Suburb

State

Post Code

Personal Representative

i.e preferred person(s) to be contacted in the event of an emergency.

Representative 1 *

Relationship *

Phone/Mobile *

Representative 1 Address

Street Address

Suburb

State

Post Code

Representative 2 *

Relationship *

Phone/Mobile *

Representative 2 Address

Street Address

Suburb

State

Post Code

PART 6: Supporting Documents

You are required to meet a 100 point identification criterion upon submission of your application.
At least one form of Photo identification MUST be provided.
If these documents are not received we cannot process your application.
The Agent/Lessor may photocopy any item and retain as part of your application.
Please tick the identifying documents you have provided with your application.

Proof Of Income

You are also required to supply the Agent/Lessor with proof of your income upon submission of your application.

Employed: Last TWO pay slips.

Self employed: Bank statements, Group Certificate, Tax Return or Accountant's letter.

Not employed: Centrelink statement.

File Upload *

Drop files here or click the button to select them. You can select several files at once, and add more at any time before you submit.

PART 7: Declaration

Please declare the following by selecting either yes or no

I, the Applicant,

1. Have never been evicted by an Agent/Lessor *

True False

2. Have no known reason that would affect my ability to pay rent *

True False

3. Was refunded the rental bond for my last address in full (if applicable) *

True False Other

4. Have no outstanding debt to another Agent/Lessor? *

True False

PART 8: Tenancy Databases

The Agency may use the following tenancy database to check the rental history of the applicant/s:

TICA, Police History Check, ID Verification Check.

PART 9: Acknowledgement

Please declare the following by selecting either true or false

I, the Applicant,

Name of Applicant *

Date

Electronic Signature (Type Full Legal Name) *

By typing your name below you authorise this Rental Application Form. You agree that your typed name constitutes your electronic signature and that the automatic timestamp recorded upon clicking "Submit" serves as the official date and time of your signature.

Agency Details

PART 1: Rental Property Details

Property Details

PART 2: Applicant Details

Contact Details

Dependants

Smoking

Pets

PART 3: Address History

Current Residential Address

Previous Residential Address

PART 4: Employment Details

Centrelink Payments

PART 5: References

Personal References

Personal Representative

PART 6: Supporting Documents

70 Points

40 Points

25 Points

Proof Of Income

File Upload *

PART 7: Declaration

PART 8: Tenancy Databases

PART 9: Acknowledgement