TitlePlease selectMrMrsMissother (please specify below)

First name*

Last name*

Email*

Date of birth*

Telephone*

Postal address

Postcode*

How long have you been at this address?*

Employment status*Please selectemployed self-employedunemployed student other (please specify below)

Employment details

Do you smoke?

Do you drive?

How many children?

Ages (e.g. 3,9,12 yrs)

Do you have pets?

Current accommodation?

Previous landlord details?

I am intersted in:

In which residential area?Goole areaSelby areaOther (please specify below

other

Type of accomodation?

Type of furnishing?

Number of bedrooms?

Max rental Value?

Do you drive?FlatTerracedSemi-DetachedDetachedBuilding plot/ LandOther/ non-standard/ unusual

Number of bedrooms?

Minimum value?£50,000£75,000£100,000£125,000£150,000£175,000£200,000£250,000£300,000£350,000above £350,000

Maximum value?£50,000£75,000£100,000£125,000£150,000£175,000£200,000£250,000£300,000£350,000above £350,000