Tenant Accommodation Request
Please provide your details to help us match you with suitable accommodation. Kindly note we do not accommodate pets or children.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Important:
We do not accommodate children or anyone under the age of 18.
Phone number:
*
Are you over the age of 18? (We cannot house under 18s)
*
Yes
No
Age
*
Gender
*
Male
Female
Non-binary
Prefer not to say
Other
Ethnicity
*
Please Select
Asian
Black or African American
Hispanic or Latino
Native American or Alaska Native
Native Hawaiian or Other Pacific Islander
White
Other
Prefer not to say
Do you have any mental health needs we should be aware of?
*
Preferred Location
*
How urgent is your need for accommodation?
*
Few weeks
1-2 months
Not urgent
Do you have a criminal history?
*
Yes
No
Reason for conviction (Put N/A if not applicable)
*
Reason for seeking accommodation
*
What type of benefits do you receive?
*
PIP
Universal Credit
Other (please specify)
Drug or Alcohol
*
Yes
No
If ticked Yes, What is your intake like?
*
History of Arson
*
Yes
No
Would you be interested in shared accommodation?
*
Yes
No
Do you know anyone also receiving benefits that you would like to move in with?
*
Yes
No
Would you prefer the property furnished or unfurnished?
*
Unfurnished
Furnished
I don't mind
Submit Request
Should be Empty: