BRIEFCASE HOMETIP REGISTRATION FORM

Name:

Address:

Country:

Email:

Phone number:

Profession:

Employed at / city:

How did you find us?

 Internet Yellow-pages A friend Other

We are looking for?

 Number of bedrooms:

The above specified premises must be?

Preference of area or city in the Netherlands:

Max distance from this city/area: (Km.)

Start date:

End date:

Rent can be up to €:

Purchaseprice can be up to €:

for how many persons must the place be suitable?

Couple(s):

Single(s):

Children:

In what way would you like us to contact you?

  (Select all that apply; use CTRL-click to select)

Agreement

 The submitter of this enrollment confirms herewith that he has read and agrees
with the "Terms and Conditions" as specified on Briefcase Hometip's website.

Other information:

BRIEFCASE HOMETIP
SARPHATISTRAAT 484 1018 GW AMSTERDAM THE NETHERLANDS
TEL +31-20-6254443 FAX +31-20-6257098
e-mail: hometip@xs4all.nl