I NEED A ROOMMATE
(Requestor)
Complete this form if you are requesting a roommate
We are USA based! We will promote your request for $10.00 a month. There is free membership for the first 25 applicants for 90 days.
Your Name:
First Name
Last Name
Today's Date
-
Month
-
Day
Year
Date
Current Address:
Parmanent Address
Present Address
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Date that you would like to move?
-
Month
-
Day
Year
Date
Birth Date:
-
Month
-
Day
Year
This DOB is used to confirm that you are over 18
What is your gender?
Please Select
Male
Female
LGBTQ
Other
work:
Student
Job
Government/ Private Sector
Other
Upload your photo (Uploading photo means that you provide permission for your photo to display on member page)
Browse Files
Cancel
of
Smoking
Non- Smoking
Statement of your hobbies and the type of roommate that you seek
What type of property would you like your roommate to have?
Full Story House
Apartment
Condo
Single Family House
Basement
Offering a room with a shared kitchen and bathroom
Offering a room with a shared kitchen and private bathroom
Do you have pets?
Please Select
YES
NO
How much are you offering per month for rent?
How did you hear about us?
Social Media (Facebook, LinkedIn, Instagram...)
College/ University Campus
Library
Social Service Referral
Promotion Code:
Submit
Should be Empty: