Room Application Form

Pre-application for one of our rooms
Your Details
Your Name*

Given NameSurname - These must be as per your identification documents
Preferred Name
Date of Birth*

DayMonthYear
DD/MM/YYYY
Mobile Number*
For our records
E-mail *
**THIS IS HOW WE WILL CONTACT YOU**

Which Room are you interested in?*
Select Room
About the Room
Have you viewed our online video of the room?*

YesNo
Do you want the room for a single or couple?*
Select Option
If couple what is the other person's full name?
THIS WILL BE USED TO MATCH YOUR FORMS
Expected rental period?*
Preferred move in date? *

DayMonthYear
Select date
Number of occupants?*
Do you understand this house is a rooming house with shared facilities?*

YesNo