Agent Form

Agent Application Form

If you wish to apply to be a Homestay Experience Agent, please fill out and submit the form below. When we receive it, we will process your form and advise Agent details as soon as possible.
Section 1 - Contact person details
Full Name of Agent

First NameLast Name
Your main language (spoken)
Your level of English (spoken)
Section 2 - Company details
Agency or company name
Agent address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Agent phone number

Area CodePhone Number
Agent mobile number

Area CodePhone Number
Agent fax number

Area CodePhone Number
Agent email
Section 3 - Declaration
(By submitting this application, you are making the following declaration to Homestay Experience)

I, the person named in Section 1 of this form submission, am offically authorised to represent the organisation noted in Section 2 of this form, and have read the Homestay Experience Privacy Statement and agree with it.

On behalf of the organisation I am authorised to represent, as noted in Section 2 of this form, I hereby authorise Homestay Experience to collect personal information about my organisation, which directly relates to this application, for the purposes of a) working to provide a better service to me and my organisation, b) providing me and my organisation with Homestay profiles and summaries in response to my future Homestay applications, and c) generally arranging homestay accommodation placements for my organisation and it's clients, as per the lodgement of my future applications.

On behalf of the organisation I am authorised to represent, as noted in Section 2 of this form, I hereby consent to receive homestay profiles, updates, notices, announcements, newsletters and/or special offers by email, sms and/or telephone call (landline or mobile), for my organisation's, and/or my organisation's clients' information, consideration or perusal, from time to time.

I certify that the information supplied on this application form is complete, true and correct.
Check this box if you agree
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Agent Application Form

Section 1 - Contact person details

Section 2 - Company details

Section 3 - Declaration