TOKYO RENTAL RESERVATION FORM FOR THE NIHONBASI BLDG.
PLEASE RETURN VIA FAX NO. (+81) 03-5652-7056
NOTE: For identification purposes, please also fax a copy of your passport.
Name:
Gender:			Date of Birth:
Nationality:			Passport no.:
Home Address:
Home Tel:			Fax no.:
E-mail:			Mobile no.:
Occupation:			Company:
Company Address:
Company Tel:
Type of Visa:			Expiration Date:
Please circle the appropriate type of room you would like to reserve, and calculate your total charge, incl.
1st month's rent + utility fee and the deposit. Next month's rent will be due 1 month after your move-in date.
	Room 202:	Room 501:	Room 201:	301/401/402:
1 month-stay	JPY 61,000	JPY 67,000	JPY 81,000	JPY 91,000
6 month-stay	JPY 60,000	JPY 66,000	JPY 80,000	JPY 90,000
12 month-stay	JPY 59,000	JPY 65,000	JPY 79,000	JPY 89,000
Utility+Internet Fee:	JPY 9,000	JPY 9,000	JPY 9,000	JPY 9,000
Refundable Deposit:	JPY 29,000	JPY 29,000	JPY 29,000	JPY 29,000
TOTAL CHARGE:
Move-in Date:		Move-out Date:
Credit Card Type:	VISA     MasterCard     JCB		Credit Card no.:
Expiration Date:
I,                                                             , hereby state that all of the information above is accurate.
I would like to reserve the above-circled type of accommodation from                        to                    (m/d/y).
I,                                                             , hereby authorize Tokyo Rental, to charge my credit card the
amount of                                 JPY and understand that once this reservation has been confirmed, these
funds are 100% non-refundable and my reservation may NOT, under any circumstances, be cancelled.
Signature                                                      Date