Let or rent your flat, house, apartment or
home with the UK's leading lettings specialist

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Landlord Details
Title:	[Please Select] Mr Mrs Miss Ms Dr Prof
Forename(s):*
Surname:*
Other Joint Landlord Details:
Title:	[Please Select] Mr Mrs Miss Ms Dr Prof
Forename(s):
Surname:
Correspondence Address:*
Town/City:*
County:*
Post Code:*
Home Tel:*
Work Tel:
Mobile Tel:
E-mail:*
Click here for the full terms of our privacy and data protection policy.   This information will be passed onto other members of Countrywide plc and may be passed onto other companies providing related services that may be of use to you. If you are NOT interested in receiving details or being contacted about such services please tick this box.
Complete the form below, if you have full details available for the property Else press the Submit to Branch button to submit the form.
Property Description:
Furniture:	[Please Select] Un-Furnished Part-Furnished Furnished Fully-Furnished
No. Bedrooms:	[Please Select] 1 Bedroom 2 Bedrooms 3 Bedrooms 4 Bedrooms 5 Bedrooms
Property Type:	[Please Select] Terraced House Semi-Detached House Detached House Bungalow Flat* Apartment Maisonette Studio
*If Flat:	[Please Select] Purpose Built Converted
Style & Decor:
Council Tax Band:
Burglar Alarm:
Rental Description:
Rental Expected:
Rental Advised:
Viewing Details:
Date Available:
Period Available:	[Please Select] 6 months 12 months LT
Viewing Arrangements:
Key:	[Please Select] Yes No
Countrywide Board:	[Please Select] Yes No
*If 'No', why?
Service Required
Letting & Full Management:
Letting and Rental Collection:
Introduction Only:
Housing Insurance Quote:
Fees Agreed
Tenancy Agreement:
Inventory:
Check-Out:
Reason for Letting:
Special Clauses:
Restrictions
Housing Benefit:	[Please Select] Yes No
Sharers:	[Please Select] Yes No
Pets:	[Please Select] Yes No
Children:	[Please Select] Yes No
Smokers:	[Please Select] Yes No
Further Information:
Click here for the full terms of our privacy and data protection policy.   This information will be passed onto other members of Countrywide plc and may be passed onto other companies providing related services that may be of use to you. If you are NOT interested in receiving details or being contacted about such services please tick this box.