We would like to get in contact with you. If you would like us to help you find a suitable home, we ask you to fill in our online registration form. Upon receipt, we will contact you soon to discuss the next steps.

My Website

Full name * (main tenant)

Full name (co-tenant)

Address & Postcode *

Telephone number * (main tenant)

Telephone number (co-tenant)

Email Address * (main tenant)

Email Address (co-tenant)

Date of birth (main tenant) *

Kids (age)

Budget monthly rent* (excl. Energy, TV & Internet)

Rental period (fixed or unlimited)

Profession

Gross monthly income (in Euro)

About me/us and my family

About the property

Description preferred property

f.e. how many bedrooms, bathrooms, preferred location

Furnished

Yes No

Pets

Yes No

Smoking

Yes No

All important additional information or requirements you want to share with us

Pricing & Conditions

Agency fee is one-off amount of one month's rent (excluding VAT)
The sum which is owned monthly to a lessor including all bills such as energy and services
Down payment € 300,- (including 21% VAT, this will be deducted from the final one-off mediation fee)

Name *

Date *

Place *

I hereby declare that I have read the above and agree to the terms and conditions.*

* After the landlord accept our offer on behalf of you as our client you owe La Brique23 the agreed agency fee. The down payment is not refundable and will be charged upfront. We agree to our personal information being shared and are aware that it is used for an official screening. After receiving this order together with the required documents and the down payment we will start up the process and will contact you for the next step.

Terms & Conditions and Privacy statement see www.labrique23.nl

Order for Relocation

About the property

Pricing & Conditions

Address

Contact

Other information