Your Details First name * (required) Last name * (required) Email * (required) Gender * Male Female Date of birth * (required) Nationality * (required) Current Address * (required) Country * (required) Smoker? * Yes No Home Phone Mobile * (required) Occupation * (required) Current Employer * (required) Employer when you arrive in Palmerston North * (required) Tertiary Institute you will be attending * (required) Course Attending * (required) Message Next of kin Name * (required) Phone * (required) Accommodation Date Accommodation Required from * (required) Expected length of stay * (required) Term Periodic Fixed - medium (up to four months) Fixed - long (four months +) Fixed term start and end date (if applicable) PERIODIC: If for any reason my stay is terminated. I agree to give 3 week's notice or payment of 3 weeks. FIXED TERM: The tenancy cannot be terminated during the fixed term period. If I wish to be released from this fixed term contact I will still be liable for the full payment of the term of the contact. Your Room * Single Room (One person only) Double Room (Two people max) Do you have a vehicle? * Yes No We'll use your details only to process your application for Baxters, as set out in our privacy policy. Send This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.
