Name : Title:       Mr. Ms. First :     Family : Date of birth : 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:    1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 Current address : Cell phone : Telephone : E-mail : E-mail (Retype) : Monthly Rent Budget : 60,000 80,000 90,000 100,000 150,000 180,000 200,000&over yen Rental length : Months: 0 1 2 3 4 5 6 7 8 9 10 11 12 Years: 0 1 2&over Number of Co-habitants : 0 1 2 3 4 5 Desired Apartment Size : Under 20㎡　 Over 20㎡ Furnishings : Furnished 　 Unfurnished Preference : (Select 1,2, or 3 in order of your priority) 1 2 3 Near Station 1 2 3 Convenient for shopping 1 2 3 Quiet Surroundings Visa status : working tourist student other  other : Nationality : Employment/School/Others Name : Address : Tel : Reference :   Name : Tel : Message : -- your message -- Please enter the anti-spam code shown to the left