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Please fill out our Request Form and we'll get back to you ...... ASAP!                   First                                     Last Name:       # of Persons 1 2 3 4 Email: (Required) Phone:  (Optional)     Fax (Optional)__________________________________________________________________________ Nationality:  Africa America Australia Canada China Europe Japan Korea New Zealand Phillipines UK Thailand Other (Asia) Other (Not Asia)   Status: I am a Student I am Employed I am a Tourist   Visa: Tourist Work Spouse Entertainment Other (on Passport) __________________________________________________________________________ I am interested in Private Shared accomodations. I am interested in 1Room 1DK 1LDK 2DK 2LDK 3LDK Shared Housing accomodations. Help with Room Descriptions My budget is per month USD AUD CAD EUR GBP       Other My Priority is: Location Budget Condition I plan to arrive in Japan: January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2007 2008 2009 I plan to stay for at least 3 months: Yes No __________________________________________________________________________ Additional Information / Requests: Formnut ALL INFORMATION IS FOR PRIVATE USE AND WILL NOT BE GIVEN OR SOLD TO ANY OTHER PARTIES