BOOKING REQUEST
If request is submitted after 4pm & accommodation is required within 24 hours, please call 1300 427 368
Please fill out the below details
CONTACT DETAILS (Person responsible for this stay)
First Name
*
Last Name
*
Company name
*
Email
*
Phone
*
INSURER DETAILS
INSURER
*
CLAIM#
*
Billing Address
*
ABN
*
OCCUPANT DETAILS
Occupant first name
*
Occupant last name
*
Occupant number
*
Occupant Email
*
Occupant Address
*
PROPERTY REQUIREMENTS
Current Property
*
House
Apartment
Unit
Home Suburb
*
State
*
Australian Capital Territory
New South Wales
Northern Territory
Queensland
South Australia
Tasmania
Victoria
Western Australia
Radius
*
<10 km
<20 km
<30 km
<40 km
Adults
*
1
2
3
4
5
6
Children Ages 2-12
*
0
1
2
3
4
5
6
Infants Under 2
*
0
1
2
3
4
5
6
Pets (Dog, Cat)
*
*Please specify
Bedrooms
*
1
2
3
4
5
Bathrooms
1
2
3
4
Carparks
1
2
3
Furniture
*
Fully Furnished
Unfurnished
Furniture Relocation
N/A
*Not applicable for short term stays
Work Suburb
Find a property close to work
Yes
No
Currently have a place to stay?
*
Yes
No
Total Approx. Budget
$100-$1,000
$1,000-$2,000
$3,000-$4,000
$4,000-$5,000
$5,000-$6,000
$6,000-$7,000
$7,000-$8,000
$8,000-$9,000
$9,000-$10,000
$10,000-$15,000
$15,000-$20,000
$20,000-$25,000
$25,000-$30,000
$30,000-$40,000
$40,000-$50,000
$50,000+
*Helps us in finding the right property for you
Check in Date
*
Check out Date
*
NOTES
End of form
Reminder: If request is submitted after 4pm & accommodation is required within 24 hours, please call 1300 427 368
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