Title:

No title Mr Mrs Ms Miss Dr

Forename:

Surname:

Address:

Postcode:

Telephone:

E-mail:*

Contact me by:*

Letter Telephone E-mail

Present Accommodation:

Accommodation list Semi-Detached House Mid-Terrace House End of Terrace House Ground Floor Flat Upper Floor Flat Ground Floor Bedsitter Upper Floor Bedsitter Ground Floor Maisonette Upper Floor Maisonette

Number of Bedrooms:

Number of Living Rooms:

Garden:

Yes No

Type of accommodation wanted:

(please include the number of bedrooms and floor required)

Area Required:

Any Area Fareham, North Fareham, South Locksheath Portchester Stubbington Sarisbury Green Titchfield Warsash

Any Area Fareham, North Fareham, South Locksheath Portchester Stubbington Sarisbury Green Titchfield Warsash

For more than 1 area please select from the second box

I/we give authorisation for my/our details to be put onto Fareham Borough Council's Mutual Exchange web page

I/we do not give authorisation for my/our details to be put onto Fareham Borough Council's Mutual Exchange web page

The accommodation must be suitable in size for both households and any rent owed must be paid before the exchange takes place. Each dwelling will have to be accepted in its existing condition.