Application Form

Complete the online form or download a printable form here

  • The first rental payment must be made by CASH or BANK CHEQUE.
  • The bond payment is to be made by BANK CHEQUE, payable to the Residential Tenancies Bond Authority (R.T.B.A.)
  • Submit one application per person

Rental Property


Tenancy Details

Preferred Commencement Date Term Rent $ pw

Applicant's Details

Full Name: Date of Birth:

Email address:

Identification: Drivers Licence no./Passport no.:
State of licence/country of passport
A.C.N Number (if self employed):

Current Address:

Phone: AH: BH: M:

No. of occupants: No. Adults: No. Children:

Pets? If yes, what type? Ages of Children:

Details of Current Landlord/Agent
BH: M:
Current rental p/w:
Length of stay:
Reason for leaving:
Details if Home Owned
Home to be:
Contact person/agency:
Length of stay:
Reason for leaving:
Sale price/rental amount:

Previous Landlord/Agent/Details if Home Owned
BH: M:
Rental Address:
Length of Stay: Rental: $

Current Occupation
Current Employer:
Employed Since:
Income $:
Your position:

Previous Occupation
Previous Employer:
Employed Period:
Income $
Your position:

Professional References - name and phone number (eg Accountant/Solicitor/Bank Manager)

Personal References - name and phone number

Emergency Contact
Next of Kin:

I confirm the following:

  • The property is offered subject to the owners approval and no action shall be taken by the applicant against the Landlord and the Agent should any circumstances arise whereby the property is not available for occupation on the due date.
  • I/We declare that the information supplied is true and correct and agree that the agent is permitted to make independent inquiries to provide information to the Landlord for the purpose of assessing my/our eligibility to rent the property.
  • I/We declare the above information is true and correct to the best of my knowledge and I understand that the Landlord reserves the right to refuse my application. If my application is accepted, I agree to take the premises as inspected and will within 24 hours of approval pay all monies in CASH or BANK CHEQUE and sign the Tenancy Agreement.
  • I/We declare that submitting this form electronically is as legally binding as a signature and thus state that the above information is true and correct and state that the Agent may accept this application as such.

Tenancy Privacy Statement

Due to recent changes in the Privacy laws, from December 21, 2001, all property managers must ensure that you fully understand the National Privacy Principles and the manner in which we must use your private information in order to carry out our role as professional property managers. Please take the time to read the Privacy Statement carefully before you submit your form.
As professional property managers, Butler and Co Property Consultants collects personal information about you. To ascertain what personal information we have about you, you may contact us.

Primary Purpose

As professional property managers, we collect your personal information to assess the risk in providing you with the lease/tenancy of the premises you have requested, and if the risk is considered acceptable, to providing you with the lease/tenancy of the premises.
To carry out this role and during the term of your tenancy, we will discolse your personal information to:

  • The Landlord.
  • The Landlord's lawer.
  • The Landlord's mortgagee.
  • Referees you have nominated.
  • Organisations / Trade people required to carry out maintenance to the premises.
  • Rental Bond Authorities.
  • Residential Tenancy Tribunals/Courts.
  • Collection Agents.
  • National Tenancy Database Pty. Ltd. (ABN 65 079 105 025) ("NTD").
  • Other Real Estate Agents and Landlords.

Secondary Purpose

We also collect your personal information to:

  • Enable us, or the Landlord's lawyers, to prepare the lease/tenancy documents on the premises.
  • Allow organizations / trades people to contact you in relation to maintenance matters relating to the premises.
  • Pay/release rental bonds to/from Rental Bond Authorities (where applicable).
  • Refer to Tribunals, Courts, and Statutory Authorities (where necessary).
  • Refer to Collection Agents/Lawyers (where default/enforcement action is required
  • Provide confirmation details for organizations contacting us on your behalf ie. Banks, Utilities (Gas, Electricity, Water, Phone), Emploters etc.

If your personal information is not provided to us and NTD, and you do not consent to the uses to which we put your personal information, we cannot properly assess the risk to our client, or carry out our duties as professional property managers. Consequently, we may not provide you with the lease/tenancy of the premises.

NTD Disclosure Statement.

You can contact National Tenancy Database Pty. Ltd. (ABN 65 079 105 025) ("NTD") by

Telephone: 03 9610 4996
Facsimile: 03 9620 7339
In Person: Level 7, 477 Collins Street, Melbourne, 3000
Mail: P.O. Box, 156, Collins Street West, Melbourne, 8007
Visit website:

Primary Purpose

NTD collects your personal information to provide to its members historical tenancy and public record information on individuals and companies who/which lease residential and commercial property from or through licensed real estate agent members of NTD.

NTD also provides credit information on companies/directors applying for commercial leases.

The real estate agent/property manager will advise NTD of your conduct throughout the lease/tenancy and that information will form part of your tenant history.

NTD usually discloses information to:

  • Licensed real estate agent member
  • NTD's parent company, Collection House Limited (ABN 74 010 230 716) and its subsidiaries
  • Credit Bureaus

By clicking "Sign and Send to Butler and Co" I acknowledge that I have read and understood this privacy statement.

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