Kidsgrove 01782 914444 Milton 01782 958944 Alsager 01270 814550 Newcastle-under-Lyme 01782 950722 Longton & Trentham 01782 291464
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Rental Application Form

Please complete the rental application form below. The information you provide will be used by the landlord for referencing purposes.

Fields marked with * are required.

Applicant Details
How many adults will be living at the property? *
Household & Lifestyle
How many dependents will be residing in the property with you? *
Please provide the age and relation of each dependent *
Do you have any pets? If so, please disclose how many pets you have and what type they are
Do you have any disabilities that we need to be aware of? (This is to ensure that the property is suitable for your needs in its current condition.)
Will anyone at the property smoke or vape? *
Referencing & Credit
Adverse credit and details for any applicant *
The referencing process requires you to undergo checks with your current landlord or agent, your affordability and a mandatory credit check. Are you aware of any reason that relates to these things that would cause your application to be unsuccessful? *
Can you provide a guarantor if required? If so, please disclose their name, email address and contact number. *
Tenancy Details
Please indicate your preferred move-in date *
How long are you wanting to rent this property for? *
Holding Fee Terms *
If your application is accepted by the landlord, you will be charged a mandatory holding fee of the equivalent of one weeks rent before you are submitted to referencing, which will later be deducted from the first month's rent. If your referencing fails as a result of any inaccurate information provided by you in this application or as a result of any relevant information being withheld by yourself, the holding fee will be non refundable. Where you pay your holding deposit and then change your mind on the property, this is also non refundable.
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Samuel Makepeace Bespoke Estate Agents Stoke on Trent, Newcastle Under Lyme & Alsager
14 Heathcote Street, Kidsgrove, Stoke-On-Trent, ST7 4AA hello@samuelmakepeace.co.uk

1 Millrise Rd, Milton, Stoke-on-Trent ST2 7BN hello@samuelmakepeace.co.uk

Office Hours

Monday to Friday
9:00 am - 5:00 pm
Saturday
8:30 am - 2:00 pm
Sunday
closed

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Copyright © 2026 Samuel Makepeace Bespoke Estate Agents Stoke on Trent, Newcastle Under Lyme & Alsager - All Rights Reserved.
Samuel Makepeace Bespoke Estate Agents is a registered trademark and trading style of Samuel Makepeace Lettings Ltd 10231335 & Samuel Makepeace Newcastle & Stoke Ltd 11646604. Registered in England and Wales. Newcastle & Stoke VAT registration number: 338 721 195
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