Rental Request Form

Fields marked with an asterisk* are required.

Your Contact Information:

*First Name:

Initial:

*Last Name:

*Street Address:
*City:	*State:	Zip:

*Daytime Phone:	Best time to phone me:
Night Phone:	Best time to phone me:
*Email:
Fax phone:

What led you to inquire about rentals from Shore & Country?

Your Rental Property Desires: Area/Location/requested:
Special facilities requested:
Property listing numbers and dates Desired:

First choice:
From:	To:
Second choice:
From:	To:

Number who will occupy the property at any one time:
Number of occupants sleeping over an any one time:
Minimum number of bedrooms required:
Minimum number of beds and sizes required: Doubles: Singles:

Your Desired Rental Price Range: Per week Price Minimum $ To Price Maximum $

Agree to Read the Conditions of Occupancy I have read and agree to abide by these provisions. Sample Conditions of Occupancy
Yes No

Thank you for providing the necessary information

Equal Housing Opportunity

Shore & Country Real Estate
Mailing: P.O. Box 69 • South Lyme, CT 06376
Office: 249 Shore Rd • Old Lyme, CT

www.CTBeach.com
email: salty@CTBeach.com
1.800.292.1695

1.888.CTBEACH
888.282.3224 • 860.434.1695
fax: 860-434-0076