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Move in Smart Customer Form

First Name:     (Note: Max 30 characters a-z and A-Z)
Last Name:     (Note: Max 30 characters a-z and A-Z)
Date of Birth:
Email Address:
Phone Number:     (Note: 20 digit number max)
Gender: Male Female
Address:



City:     (Note: Max 30 characters a-z and A-Z)
Zip/Postal Code:     (Note: 6 digit number max)
State:     (Note: Max 30 characters a-z and A-Z)
Country:     (Note: Max 30 characters a-z and A-Z)
Purpose of Visit:


Job Relocation
Study Abroad
Other (please specifty)  
Any pet(s):


Yes
No
If yes, what kind? 
Minimum Length of
Stay in the USA:




6 Months
12 Months
24 Months
Other (please specifty)  
Preferred Living Area:



Near Job
Campus
Center City
Suburbs
Multiple (please specifty)  
Any Interest in
Roomate:


Yes
No
Maybe
Are you Interested in:



1 Bedroom / 1 Bath
2 Bedroom / 1 Bath
2 Bedroom / 2 Bath
3 Bedroom / 2 Bath
Multiple (please specifty)  
Rent Monthly Budget
per person):




Under $750
Under $1,000
Under $1,500
Under $2,000
More
Preferred color(s)
for furniture:





Black
White
Wood
Red
No Preference
Preferred Sport:




Basketball
Hockey
Baseball
American Football
Any comments you feel
may be of interest for
us to support you in
your relocation:






Which offer are you
interested in:




Move in Basic
Move in Premium
Move in Luxury
I don't know yet
Did anyone refer you
to Move In Smart?: