Application for Occupancy - Hostel Headquarters

Date:
   
Surname
   
First Names:
   
Name also known by:
   
Gender: Male Female
   
Date of Birth
   
Nationality:
   
Current Address
   
City:
   
Country:
   
Smoker: Yes No
   

CONTACT DETAILS

  
   
Phone Home
   
E-Mail:
   
Mobile:
   
Occupation:
   
Current Employer:  
   
Employer when you arrive in Palmerston North:
   

OR

  
   
Tertiary Institute you will be attending:
   
Course Attending:
   

NEXT OF KIN

  
   
Name:
   
Phone:
   
Please provide details of any known medical or psychiatric condition:
   
Do you have a vehicle: Yes No
   
Date accommodation required from
   
Expected length of stay:
   
IMPORTANT: Please choose between Periodic or Fixed Term:
 Periodic Fixed Term
   

PERIODIC:
If for any reason my stay is terminated, I agree to give 3 week's notice or payment of 3 weeks.

FIXED TERM:
From to
The tenancy cannot be terminated during the fixed term period. If I wish to be released from this fixed term contact I will still be liable for the full payment of the term of the contact.

PREFERENCE WILL BE GIVEN TO THOSE WHO APPLY FOR FIXED TERM
ROOM (choose one):
Single Room
$160 per week (One Person Only)
  or
Double Room
$210 per week (Two Persons Maximum)
   
Upon acceptance of this application the following payment will be required.

RENT: 3 weeks rent in advance
DEPOSIT (BOND): $500 per person (Refundable)

CANCELLATION

If cancellation of booking is made outside 21 days of intended arrival date, there will be an administration charge of one week rent. Cancellation between 8-21 days, will incur an administration charge of two weeks rent. Cancellation within 7 days, will incur an administration charge of three weeks rent and loss of deposit

Upon acceptance of this application I will be asked to sign a 'Code of Conduct Contract'. Once I sign this contract I am signing a legal document stating that I fully understand and agree to be bound by the conditions.

I hereby apply for admission to reside at Baxter's on Ranfurly or Palmy 31 . Any false information on this application form may result in immediate termination of my tenancy.

Signed

   
Once complete print out form and either:
   
Post to:

Hostel Manager
P.O. Box 1603
Palmerston North
New Zealand

 Fax to:

(06) 353 5359
OR
(06) 358 0050