J & J Houselet Ltd.,

Your details and  Contact name 

First Name
Last Name
Title Mr.Mrs.Ms	SLA No:
Organization
Street Address
Address (cont.)
City
County
Post Code
Country
Work Phone
FAX
E-mail

Tenants full name and date of birth (including maiden name if applicable)

Name
Maiden Name
Date of Birth	dd/mm/yy

Tenants current address 

(including post code)

Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Work Phone
Home Phone
FAX
E-mail

Please indicate the status of your current address

Councill Tenant Private Tenant Owner Living with parents House share (informal. Not as the tenant) Other

Reason for leaving

Previous address 1 

(if less than 3 years)

Street Address
Address (cont.)
City
County
Post Code
Country

Previous address 2 

(if less than 3 years total at previous addresses)

Street Address
Address (cont.)
City
County
Post Code
Country

Please provide the address you are applying for

Street Address
Address (cont.)
City
County
Post Code
Country

Rent payable on new property £

How will you pay the rent? Employment Benefits Other

If you answered "other" to the previous question please define.

Current landlord or letting agent 

( previous if you have already left)

Name
Title Mr.Mrs.Ms
Organization
Street Address
Address (cont.)
City
County
Post Code
Country
Work Phone
FAX
E-mail

Current employment details

Contact Name
Title Mr.Mrs.Ms
Organization
Street Address
Address (cont.)
City
County
Post Code
Country
Work Phone
FAX
E-mail

Previous employer if less than 6 months

Name
Title Mr.Mrs.Ms
Organization
Street Address
Address (cont.)
City
County
Zip/Postal Code
Country
Work Phone
FAX
E-mail

Accountants details 

(self employed only)

Name
Title Mr.Mrs.Ms
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
FAX
E-mail

Bank details 

(self employed only)

Name
Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
FAX
E-mail

Enter your account name in the space provided below.

Account number maximum 9 digits

Sort code in the format   00-00-00 

Personal reference 

(must not be related)

Name
Title Mr.Mrs.Ms
Street Address
Address (cont.)
City
County
Post Code
Country
Work Phone
Home Phone
FAX
E-mail

Length of time known  Years

Relationship to applicant

Next of Kin

Name
Title Mr.Mrs.Ms
Street Address
Address (cont.)
City
County
Post Code
Country
Home Phone

PLEASE READ THE FOLLOWING STATEMENT CAREFULLY 

 ONLY SUBMIT IF YOU AGREE

 By submitting this form the applicant agrees to the following:-

I authorise you to disclose any information about me to any credit reference agency who may retain a record of any such search and may share the information with other lenders. The information registered is used only to help make credit and insurance decisions or for fraud prevention or tracing of debtors. I declare that I have never been bankrupt or entered into any agreement with my creditors or had any judgment for debt outstanding.

I declare that the supplied information is to the best of my knowledge true. I have no objection to this information being verified by whatever means deemed necessary.

An application by more than one party  to the agreement will result in a financial connection between those individuals being established  at the credit reference agency.

  IF THIS FORM IS BEING SUBMITTED BY A LANDLORD OR AGENT THE FOLLOWING STATEMENT APPLIES

The submission of this form confirms that the Landlord or agent has the applicants 

permission to perform the checks stated above.

 After submitting click Pay to go to our secure payments page