RE/MAX

Personal information:

Gender

Initials

First name

Infix name

Surname

Current address information:

Street

House number

Postal code

Home town

Country

Other information

Date of birth

Email address

Mobile number

Net income*

Identity Card no*: * The number that is shown on your identity card: Driving license (Driving license number) or Identity card (Personal no.) or Passport (Passport no.)

Maximum rent per month (in whole euro's) *

Preferred starting date rent *

Number of occupants *

Furnished?

Minimal period rent

Do you have pets?

I would like to receive new offers and (price) changes in my mailbox.

I have completed this form truthfully and agree to the mediation conditions that are listed below. *