NH Housing Request Form

Housing Request Form

Submit a request for temporary housing. Please complete this form with as much detail as possible help our team better assist your needs.
Contact
Full Name

First NameLast Name
Email
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Phone Extension
Claim
Insurance / Relocation Company
Claim Number
Adjuster / Relocation Specialist Name
Damaged Residence Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Housing Needs
Desired Location
e.g. City/State, Zip code, school district etc.
Preferred City
Preferred State
Desired Move-In Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Estimated Length of Stay
Estimated in months. "+" indicates the potential to extend beyond the identified number of months
Estimated Monthly Budget
This estimate assists our team in finding suitable housing that fits your needs within your budget.
Bedrooms Needed
Bathrooms Needed
Household
Number of Adults (18+)
Must be 18 or older
Number of Children
Must be 17 or younger
Number of Pets
Number and Type of Pet(s)
Please indicate the number of pets and whether they are dogs, cats, etc.
Notes
Additional Notes or Special Requests
e.g. Single level home, walk-in shower, etc.
Should be Empty:

Housing Request Form