| Company Name | |
| Client Name * | |
| Address * | |
| Account Address * | |
| Date Required * | |
| Term * | |
| Real Estate Agent * | |
| Keys & Access * | |
| Phone * | |
| Fax * | |
| Quan. of People in Residence * | |
| Quan. of Bedrooms * | |
| Quan. of Bathroom * | |
| Dining Suite | |
| Please Select: | |
| Kitchen Suite | |
| Please Select | |
| Lounge Suite | |
| please select | |
| Lamp Table | |
| Coffee Table | |
| Television Set | |
| DVD Player | |
| Entertainment Unit | |
| Floor Lamp | |
| Table Lamp | |
| Floor Rug | |
| Wall Clock | |
| Arm Chair | |
| Kitchen Package | |
| Toaster | |
| Kettle | |
| Microwave | |
| Refridgerator | |
|
