<h3>Online Rental Application Form</h3>
Please fill out all applicable fields below.
<div class="row">
  <div class="col-md-12">
    <label>Tenancy start date</label>
    [text tenancy-start class:form-control placeholder "Start Date DD/MM/YYYY"]
    </div>
</div>
<div class="row">
  <div class="col-md-8">
    <label>Property Address*</label>
    [text* property-address class:form-control placeholder "Property Address"]
  </div>
  <div class="col-md-4">
    <label>Suburb*</label>
    [text* property-suburb class:form-control placeholder "Property Suburb"]
  </div>
</div>
<div class="row">
  <div class="col-md-6">
    <label>Rent per week</label>
    [text rent-per-week class:form-control placeholder "Rent Per Week"]
    </div>
  <div class="col-md-6">
    <label>Bond</label>
    [text bond class:form-control placeholder "Bond"]
    </div>
</div>
<br/>
<h3>Your Details</h3>
<div class="row">
  <div class="col-md-6">
    <label>Full Name*</label>
    [text* full-name class:form-control placeholder "Full Name"]
  </div>
  <div class="col-md-6">
    <label>Your Email*</label>
    [email* your-email class:form-control "Your Email"]
  </div>
</div>
<div class="row">
  <div class="col-md-6">
    <label>After Hours Phone</label>
    [text after-hours-phone class:form-control placeholder "After Hours Phone"]
  </div>
  <div class="col-md-6">
    <label>Business Hours Phone</label>
    [text business-hours-phone class:form-control placeholder "Business Hours Phone"]
    </div>
</div>
<div class="row">
  <div class="col-md-6">
    <label>Mobile Phone</label>
    [text mobile-phone class:form-control placeholder "Mobile Phone"]
    </div>
  <div class="col-md-6">
    <label>Your Date Of Birth</label>
    [text your-date-of-birth class:form-control placeholder "Your Date Of Birth DD/MM/YYYY"]
    </div>
</div>
<h3>Please indicate who else will be residing with you</h3>
<h4>Person One</h4>
<div class="row">
  <div class="col-md-12">
    <label>Name</label>
    [text one-person-name class:form-control placeholder "One Person Name"]
  </div>
</div>
<div class="row">
  <div class="col-md-6">
    <label>Relationship</label>
    [text one-person-relation class:form-control placeholder "Relationship"]
    </div>
  <div class="col-md-6">
    <label>Age range</label>
    [select one-person-age-range class:form-control include_blank "Less than 1" "1-5" "6-10" "11-20" "21-30" "31-40" "41-50" "51-60" "71-80" "Greater than 80"]
   </div>
</div>
<h4>Person Two</h4>
<div class="row">
  <div class="col-md-12">
    <label>Name</label>
    [text two-person-name class:form-control placeholder "Person two Name"]
  </div>
</div>
<div class="row">
  <div class="col-md-6">
    <label>Relationship</label>
    [text two-person-relationship class:form-control placeholder "Relationship"]
  </div>
  <div class="col-md-6">
    <label>Age range</label>
    [select two-person-age-range class:form-control include_blank "Less than 1" "1-5" "6-10" "11-20" "21-30" "31-40" "41-50" "51-60" "71-80Greater than 80"]
  </div>
</div>
<h4>Person Three</h4>
<div class="row">
  <div class="col-md-12">
    <label>Name</label>
   [text three-person-name class:form-control placeholder "Person Three Name"]
  </div>
</div>
<div class="row">
  <div class="col-md-6">
    <label>Relationship</label>
    [text three-person-relationship class:form-control placeholder "Relationship"]
  </div>
  <div class="col-md-6">
    <label>Age range</label>
      [select three-person-age-range class:form-control include_blank "Less than 1" "1-5" "6-10" "11-20" "21-30" "31-40" "41-50" "51-60" "71-80Greater than 80"]
  </div>
</div>
<div class="row">
  <div class="col-md-12">
    <label>Do any of you smoke?</label>
    [radio DoYouSmoke use_label_element default:1 "Yes" "No"]
  </div>
</div>
<h3>References</h3>
  <label>Your current address*</label>
  [textarea current-address  class:form-control]
  <label>Your previous address*</label>
  [textarea previous-address  class:form-control]
<h3>Agent Details (if rental)</h3>
<div class="row">
  <div class="col-md-12">
    <label>Company Name</label>
    [text companyname class:form-control placeholder "Company Name"]
    </div>
</div>
<div class="row">
  <div class="col-md-6">
    <label>Contact Person</label>
   [text contact-person class:form-control placeholder "Contact Person"]
    </div>
  <div class="col-md-6">
    <label>Phone Number</label>
    [text phone-number class:form-control placeholder "Phone Number"]
    </div>
</div>
<h3>Second Agent Details (if rental)</h3>
<div class="row">
  <div class="col-md-12">
    <label>Company Name</label>
    [text companyname1 class:form-control placeholder "Company Name"]
    </div>
</div>
<div class="row">
  <div class="col-md-6">
    <label>Contact Person</label>
   [text contact-person1 class:form-control placeholder "Contact Person"]
    </div>
  <div class="col-md-6">
    <label>Phone Number</label>
    [text phone-number1 class:form-control placeholder "Phone Number"]
    </div>
</div>
<div class="row">
  <div class="col-md-12">
    <label>Have you ever owned a home?</label>
    [radio have-you-ever-owned-a-home use_label_element default:1 "Yes" "No"]
  </div>
</div>
<h3>Employment</h3>
<div class="row">
  <div class="col-md-6">
    <label>Your Occupation</label>
    [text your-occupation class:form-control placeholder "Your Occupation"]
    </div>
  <div class="col-md-6">
    <label>Currently Employed With</label>
    [text currenty-employed-with class:form-control placeholder "Currently Employed With"]
    </div>
</div>
<div class="row">
  <div class="col-md-12">
    <label>Length of current employment</label>
    [text length-of-current-employee class:form-control placeholder "Length of current employment"]
   </div>
</div>
<h3>General Information</h3>
  <label>What type of accommodation do you require? (e.g. House, flat? No of bedrooms? Garage? etc)</label>
     [textarea accommodation-required class:form-control]

  <label>Rental range (weekly)</label>
  [text rental-range class:form-control placeholder "Rental range (weekly)"]

<div class="row">
  <div class="col-md-12">
    <label>Do you have pets?</label>
   [radio do-you-have-pests use_label_element default:1 "Yes" "No"]
  </div>
</div>
<div class="row">
  <div class="col-md-6">
    <label>Drivers License Number</label>
    [text driver-license-number class:form-control placeholder "Drivers License Number"]
    </div>
  <div class="col-md-6">
    <label>Drivers License State</label>
   [select drivers-license-stat class:form-control include_blank "VIC" "NSW" "QLD" "TAS" "ACT" "SA" "NT" "WA"]
  </div>
</div>
<div class="col-md-12">
  <label>Closest relative not living with you</label>
  [text close-relative class:form-control placeholder "Closest relative not living with you"]
</div>
<div class="col-md-12">
  <label>Phone number</label>
   [text phone-number class:form-control placeholder "Phone Number"]
  </div>
<h3>Personal Reference</h3>
  <label>Additional comments</label>
   [textarea additional-comments class:form-control]
  </div>
<div class="row">
  <div class="col-md-12">
    <label>I authorise that the above information may be used to carry out a credit check on me. I also agree that should I be in breach of any express or implied provision of the tenancy agreement or any provision of the Residential Tenancies Act, that I will pay the Landlord's costs incurred in undertaking collection action to recover his/her losses.</label>
   [radio authorized-term use_label_element default:1 "Yes" "No"]
  </div>
<div class="row">
  <div class="col-md-12">
    [submit  "submit"]
  </div>
</div>