Electronic Form for Temporary Housing

The Relocation Exchange - Electronic Request Form for Temporary Housing

Fields marked in red are mandatory

Your name:
Your title:
Company's name:
Mailing address:
City:
State:
Zip:
Daytime phone: Ex: (123) 555-1234
Fax:
Email Address:
Best day to call:
Best time:
Time zone:

Where would you like to live?
(Please specify city and state)

Approximately how much do you plan to spend on rent per month?(Including rent, furniture, housewares, utilities, telephone, etc.)

Desired unit size:

Number of people occupying unit:

Do you have any pets?
Yes No
If yes, please describe the number, breed, and weight of each pet:

Do you need to be convenient to a particular location?(Please specify)

Approximate dates desired:

Comments:

Disclaimer:

By submitting this form, I am requesting The Relocation Exchange to contact me about properties in which I may be interested. The Relocation Exchange may contact me at the mailing address, email address, phone number, and/or fax number provided.