Full name:..............................................................

Address 1:.............................................................

Address 2:.............................................................

Address 3:.............................................................

Postcode:...........................................

Tel no:...............................................

Fax:..................................................

Number of Adults:......................................

Number of Children:......................................

Number if Pets:......................................

Type of Rental Property Required:......................................

Preferred Tenancy Start Date from ...........................How many years...................................

If short duration please specify dates required, price will be give by email.

Start Date----------     End Date------------

Date:..........................................

Signed:.......................................................

Mrs. V Holmes
29 Rue St Blaise
11700
Rieux Minervois