first name
surname
email address
home phone
mobile
work phone
current address
How long have you been at your current address?
If less than one year, what was your previous address?
Date of Birth (dd/mm/yy)
Are you on the electoral register? yes no
Annual Salary Up to £10,000 £10,000 - £20,000 £20,000 - £30,000 £30,000 - £40,000 £40,000 +
Employer (name and address)
Are you claiming housing benefit?
Do you intend to claim housing benefit?
Do you smoke? yes no
Have you got any children? yes no
If you have got children, list their ages below (eg 14, 12)
Have you got any pets? yes no
Please select the type of accommodation you are looking for. You can make more than one selection.
house bedsit studio flat shared house flat furnished unfurnished garden parking gas central heating
How many bedrooms would you like? one two three four five or more
Preferred rental areas
Maximum rent
Number of occupants 123456+
Click here to read our terms and conditions
