Mutual Exchange Application Form

							                                                                                 MUTUAL EXCHANGE

 The information you give us here will be used to try to find you a    We may be able to send you a list of people who are
 partner to swap homes with.                                           interested in your home. You can then choose if you want to
 We may advertise your home using the internet, East End Life          see their home.
 newspaper or our brochure.                                            You do not have to swap with anyone unless you want to.
 We will NOT publish your full address or your personal details.       This will not affect your housing list application.


                                                          ABOUT YOU


       NAME



    ADDRESS




                                            ABOUT WHERE YOU LIVE NOW

 FLAT                                             No. OF BEDROOMS

 MAISONETTE                                       FLOOR LEVEL                                           LIFT          Yes / No
 HOUSE                                            RENT (per week)                    £
 BUNGALOW                                         TYPE OF HEATING

     GARDEN                              RIGHT TO BUY                           SEPARATE BATHROOM / WC
                                                                                ADAPTED FOR A WHEELCHAIR USER
     ENTRYPHONE                          PETS ALLOWED

     CONCIERGE                           DOUBLE GLAZING


                                   ABOUT WHERE YOU WANT TO MOVE TO

TYPE OF PROPERTY                        FLAT / HOUSE / MAISONETTE / BUNGALOW / ANY

NUMBER OF BEDROOMS                                                    HIGHEST FLOOR LEVEL

AREAS




I agree that my home can be advertised to try to find me a partner to swap homes with.


Signature ____________________________________________________ Date ____________