Application Form

I/We would like Direct Connect to arrange for the connection and disconnection of the following nominated utility services.
Yes
No

Once we have received this application we will call you to confirm your details.

Direct connect will make all reasonable efforts to contact you within 24 hours of the nearest working day on receipt of this Application to confirm the information on this Application and explain the details of the services offered.

Please tick utilities as required:

Electricity
Gas
Telephone
Water
Internet
Pay TV
Insurance

DECLARATION AND EXECUTION: By submitting this application, I/we: consent to Direct Connect arranging for the connection and disconnection of the nominated utility services and to providing information contained in this application to utility providers for this purpose; acknowledge having been provided with terms and Conditions of Supply of Direct Connect and having read and understood them together with the Privacy Collection Notice set out below; declare that all the information contained in this application is true and correct and given of their own free will; expressly authorise Direct Connect to provide any information disclosed in this Application to a supplier or potential supplier of the Services in accordance with the Privacy Collection Notice and to obtain any information necessary in relation to the Services; expressly authorise Direct Connect to provide any information disclosed in this Application to an information provider for the purpose of that information provider disclosing it to a supplier or potential supplier of the Services in accordance with the Privacy Collection Notice and to obtain any information necessary in relation to the Services; consent to Direct Connect contacting me by telephone or by SMS in relation to the marketing or promotion of all of the services listed under the heading "Connection Details" above even if we/I have not applied for the connection of those services in this application. This consent will continue [for a period of 1 year from the date of our/my execution of this application/until [28] days after we/I disconnect the last of the services in respect of which this application is made]; acknowledge that this consent will permit Direct Connect to contact us/me even if the telephone numbers listed on this application form are listed on the Do Not Call Register; understand that under the requirements of the Privacy Act 1988, Direct Connect will ensure that all personal information obtained about me/us will be appropriately collected, used, disclosed and transferred and will be stored safely and protected against loss, unauthorised access, use, modification or disclosure and any other misuse; authorise the obtaining of a National Metering Identifier (NMI) for my residential address to obtain supply details; consent to Direct Connect disclosing my/our details to utility providers (including my/our NMI and telephone number); declare and undertake to be solely responsible for all amounts payable in relation to the connections and/or supply of the Services and hereby indemnify Direct Connect and its officers, servants and agents and hold them indemnified against any charges whatsoever in respect of the Services; acknowledge that, to the extent permitted by law, Direct Connect shall not be liable for any loss or damage (including consequential loss and loss of profits) to me/us or any other person or any property as a result of the provision of the services or any act or omission by the utility provider or for any loss caused by or in connection with any delay in connection, disconnection or provision of, or failure to connect or disconnect or provide, the nominated utilities; acknowledge that whilst Direct Connect is a free service I/we may be required to pay standard connection fees or deposits required by various utility providers; acknowledge that the Services will be provided according to the applicable regulations and that the time frames and terms and conditions of the nominated utility providers bind me/us and that after hours connections may incur additional service fees from utility providers; acknowledge that the real estate agent listed on this application form may receive a benefit from Direct Connect in connection with the provision of the service being provided to me/us by Direct Connect; and acknowledge the entitlement of Direct Connect and its associates, agents and contractors, to receive a fee or remuneration from the utility provider and that such fee or remuneration will not be refunded to me as a rebate in connection with the provision of the utility connection services.

By signing this application form, I warrant that I am authorised to make this application and to provide the consents, acknowledgements, authorisations and other undertakings set out in this application form on behalf of all applicants listed in this application form.

I/We agree to the above terms & conditions

P: 1300 664 715          F: 1300 664 185          W: www.directconnect.com.au          PO BOX 1519, BOX HILL, VICTORIA

I hearby offer to rent the property from the owner under a lease to be prepared by the Agent. Should this application be accepted by the landlord I agree to enter Into a Residential Tenancy Agreement.

I acknowledge that this application is subject to the approval of the woner/landlord. I declare that all information container in this application (including the revere side ) is tru and corrrect and given of my own free will. I adeclare that I have Inspected the premises and am not bankrupt.

I authorise the Agent to obtain personal Information from:
(a) The owner or the Agent of my current or previous resience;
(b) My personal referees and employer/s;
(c) Any record listing or database of defaults by tenants;
If I default under the rental agreement, I agree that the Agent may disclose detals of any such default to a tenancy default database, and to agents/landlords of properties I may apply for in the future.

I am aware that the Agent will use and discloe my personal information in order to :
(a) communicate with the owner and select a tenanct
(b) prepare lease/tenancy documents
(c) allow tradespeople or equivalent organisations to contact me
(d) lodge/claim/transfer to/from a Bond Authority
(e) refer to Tribunals/Courts & Statutory Authorities (where applicable)
(f) refer to collection agents/lawyers(where applicable)
(g) complete a credit card with NTD (National Tenancies Database)
(h) transfer water acount details into my name

I am aware that if information is not provided or I do not consent to the uses to which personal information is put the Agent cannot provide me with the lease/tenancy of the premises. I am aware that I may access personal information on the contact details above.

Initial payment must be made by cash, bank cheque or money order within 24 hours after approval of application. No Personal Cheques accepted.

I acknowledge that my application is subject to the owners' approval and the availablity of the premises on the due date. No action will be taken against the Landlord or Agent if the applicant is unsuccessful or upon acceptance should the premises not be ready for occupation on this date, for whatever reason. I accept that rental amounts are subject to change by providing the required notice.

Disclaimer

I confirm the following

1. During my inspection of this property I found it to be in relatively clean condition OR

2. I believe the following items should be attended to prior to my tenancy commencing. I acknowledge that these items are subject to the owner's approval.

Please provide us with 100 points of identification