| TOKYO RENTAL INTERNATIONAL RESERVATION FORM. |
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RETURN VIA FAX NO. (+81) 03-5652-7056 |
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| NOTE:
For identification purposes, please also fax a copy of your passport. |
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| Name: |
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| Gender: |
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Date of Birth: |
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| Nationality: |
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Passport no.: |
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| Home Address: |
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| Home Tel: |
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Fax no.: |
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| E-mail: |
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Mobile no.: |
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| Occupation: |
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Company: |
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| Company Address: |
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| Company Tel: |
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| Type of Visa: |
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Expiration Date: |
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| 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. |
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Private Room: |
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Shared Room: |
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| 1 month-stay |
JPY 61,000 |
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JPY 31,000 |
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| 6 month-stay |
JPY 60,000 |
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JPY 30,000 |
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| 12 month-stay |
JPY 59,000 |
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JPY 29,000 |
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| Utility+Internet Fee: |
JPY 9,000 |
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JPY 9,000 |
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| Refundable Deposit: |
JPY 29,000 |
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JPY 29,000 |
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| TOTAL CHARGE: |
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| Move-in Date: |
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Move-out Date: |
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| Credit
Card Type: |
VISA
MasterCard JCB |
Credit Card no.: |
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| Expiration
Date: |
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(month/year) |
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| 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. |
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Signature Date |
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