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1. About You
Please leave blank:
Title:
Mr
Mrs
Miss
Dr
Other
First Name:
Surname:
Email:
Date of birth:
Phone Number:
Address:
Postcode:
How long have you lived at address?
2. Additional Information
Employment Status (please select):
Employed
Self-Employed
Unemployed
Student
Other
If other, please provide details:
Company Name:
Position at company:
Do you smoke?
Yes
No
Do You Have Pets?
Yes
No
Do Have Children?
Yes
No
If yes to any of the above, please provide details:
Is your current accommodation (please select):
Rented
Owned
Staying with relatives
Other
Previous landlord details:
Have you had any County Court Judgements (CCJs) or bankruptcy orders against you? Yes/No:
Do you have criminal convictions? Yes/No:
If yes to any of the above, please provide details:
2A. About Your Partner
Title:
Mr
Mrs
Miss
Dr
Other
Partner First Name:
Partner Surname:
Date of birth:
Email:
Phone Number:
Address as above:
Yes
No
If no, please enter full address:
Partner Employment Status (please select):
Employed
Self-Employed
Unemployed
Student
Other
If other, please provide details:
Company Name:
Position at company:
Does your partner smoke?
Yes
No
Does your partner have pets?
Yes
No
Does your partner have children?
Yes
No
If yes to any of the above, please provide details:
Is your partner's current accommodation (please select):
Rented
Owned
Staying with relatives
Other
Previous landlord details:
Has your partner had any County Court Judgements (CCJs) or bankruptcy orders against you? Yes/No:
Does your partner have any criminal convictions? Yes/No:
3. Property Details
Are you enquiring about a specific property - if so, which one?
Are you searching for a particular area? Please give details:
Which type of accommodation are you looking for?
Flat
House
Would you like to stay up to date with new properties that become available?
Yes
No
Furnished?
Yes
No
How many bedrooms?
1
2
3
4
5
6+
Maximum rental price (£ PCM):
When are you able to attend viewings?
Any other relevant information?
How did you hear about us? (Please select from dropdown):
Not Specified
Zoopla
Rightmove
On The Market
Other Web Advertising Portal
Recommendation
Already Knew About You
Saw Your Office
Other
If other, please provide details:
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