* Required Information
Client Information
Name *
Gender
Male
Female
Date of Birth
/
/
(dd/mm/yyyy)
Contract Type *
Individual
Corporate
Corporation
Company Representative
Telephone
-
-
Facsimile
-
-
Mobile
-
-
E-mail *
Preferable P.O.C.
Home
Office
Mobile
Email
Others
Requested Accommodation
Room Type
Furnished serviced Apartment@
Unfurnished Apartment
Move-in Date
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
/
1
2
3
4
5
6
7
8
9
10
11
12
/
2009
2010
(dd/mm/yyyy)
Length of Stay
1
2
3
4
5
6
7
8
9
10
11
12
Month
1-2 Years
More than 2 Years
Room Layout
Studio
1BR
1BR{Study
2BR
Budget
none specified
400,000
500,000
600,000
700,000
800,000
900,000
1,000,000
1,100,000
1,200,000
1,300,000
1,400,000
JPY `
none specified
450,000
550,000
650,000
750,000
850,000
950,000
1,050,000
1,150,000
1,250,000
1,350,000
1,450,000
JPY
Size
none specified
40
50
60
70
80
90
100
110
sqm `
none specified
45
55
65
75
85
95
105
115
sqm
Number of Guest(s)
Adult :
/ Children :
(age :
age :
)
Purpose of Visit
Business (Business Trip/Transfer/Training )
Relocation
Sightseeing
Others
Where did you hear about
Pacific Tower Roppongi?
Pamphlet
Newspaper
Web Search
PTR HP
Enplus HP
Referral - HR
Referral - Friend/Family
Others
Other Requests
Please call Enplus Inc. 03-3511-8051
