Classified ID:
First Name:
Last Name:
E-Mail Address:
Home Phone:	--
Work Phone:	--
Pager:	--
Cell Phone:	--
Fax:	--
Address:
Apt.:
City:
State:	AA AE AL AK AP AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY
Zip Code:

WHAT IS YOUR DESIRED APARTMENT'S DESCRIPTION?

Bedrooms:	------ Efficiency 1 Bedroom 2 Bedroom 3 Bedroom
Planned Move Date:	Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Day 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 Year 2010 2011
Plan to start looking:	Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Day 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 Year 2010 2011
1st Choice Location:	------ 1960/Northside Alief Baytown/Channelview Bear Creek Clear Lake Ft. Bend Galleria Galveston Humble/Kingwood Inner Loop Katy Medical Center Northwest Pasadena/Deer Park Sharpstown Southwest Westchase Woodlands
2nd Choice Location:	------ 1960/Northside Alief Baytown/Channelview Bear Creek Clear Lake Ft. Bend Galleria Galveston Humble/Kingwood Inner Loop Katy Medical Center Northwest Pasadena/Deer Park Sharpstown Southwest Westchase Woodlands
Price/Rental Rate:	------ 400 450 500 550 600 650 700 750 800 900 1000 1100 1250 1500 1750 2000
Lease Term Desired:	------ 12 Months 6 Months 3 Months or Less
Washer & Dryer:	------ Must Have Connections Only Don't Want
Pets:	------ Cat Dog under 30 lbs Dog b/t 30 and 50 lbs Dog b/t 50 and 100 lbs Dog over 100 lbs

HOW CAN WE CONTACT YOU?

Send Info Via?	E-mail: YES NO
	U.S.Mail: YES NO
	Fax: YES NO

DO YOU HAVE ANY SPECIAL NEEDS!

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