1. Applicant Details:

Name (required)

Address (required)

Telephone Numbers
Day (required)

Evening

Mobile

Email (required)

Occupation

2. Accommodation

2.1 Housing Stock
(Please specify the total number of properties within your portfolio)

2.2 Location
Please specify which cities you cover

2.3 Type
(Please specify)
 Terrace
 Semi-detatched
 Detatched
 Bungalow
 Farm House
 Flat
 Bed-Sit
Other

3. Rates
(please specify)

Rent (PCM)

Security Deposit

4. Terms and Contidions
(Please specify your requirements where applicable)

Rent in advance
 Yes No

Security Deposit
 Yes No

Tenancy Agreement
(Shortest Length)

5 Any Other Comments
(Please use the space below to provide any further useful information)