• * Is this for a private individual or company employee? Private Company
• Your Company Name (If Company)
• *Your Name
• *Address Line #1
• Address Line #2
• *City , *State AK AL AR AZ CA CO CT DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY , *Zip
• *E-mail
• *Phone
• Fax
• *Preferred Contact Method Phone Email
• Employee Name (if company relo)
• How Many Adults , Children , Age(s)
• * Length of Stay (30 day min.) Days Weeks Months Years

Housing Needs

• *Preferred Housing Apartment House Condo Mobile Home Trailer
• *Size Desired: Bedroom(s) S 1 2 3 4+ ; *Bathroom(s) 1 2 3+
• *City & State Desired ; Boundaries N S E W
• Close to this specific address w/zip
• *Move in Date January February March April May June July August September October November December , 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 ,
• *Monthly Budget Please Select $1,500 - $2,000 $2,000 - $2,500 $2,500 - $3,000 $3,000 - $3,500 $3,500 - $4,000 $4,000 - $4,500 $4,500 - $5,000 $5,000 - $5,500 $5,500 - $6,000 Click here for standard package rates
  Rates and amenities may vary based on location, availability, and length of stay.
  If your budget falls below the listed ranges, your request will not be processed
• *Pets Yes No How Many? 0 1 2 3 4 5+ Breed Weight lbs.
  2nd Pet Weight (if applicable) Breed Weight lbs.

Hotel

• *Do You Need a Hotel? Yes No
  (*note - If yes, complete our Hotel form upon submission of this application)
• Currently Staying in Hotel? Yes No ; If yes, What Hotel?
  Hotel Phone Number ; Room Number

Finding RHS

• *Search Engine Used Google Yahoo MSN Alta Vista Ask Jeeves Other Not Used
• *Referred By CorporateHousing.com RHS Website Friend Other

Additional Info / Comments