Title

First name

Surname

Address

Town/City

Postcode

Home Telephone

E-mail Address

Are you working?

Are you claiming housing benefit?

Are you in rented accomodation at present?

If Yes please give contact details for your

current landlord

Give your preferred location

Property type (Use Ctrl Key to select more than one)

Number of bedrooms

Gardens

How soon do you wish to move?

Maximum rent £pcm