All your information will be handled confidential. Only with your
approval we shall give your personal details as address, e-mail,
or phone number to an interested party. |
| Name, surname |
M
F |
| Street |
|
| Postal code and city |
|
| Province |
|
| Country |
|
| Tel. Home |
|
| Fax |
|
| Email |
|
| |
|
| Number of persons taking part in the exchange: |
adults;
teens;
children
Languages spoken: mother tongue
Other languages:
|
| More
information about above mentioned persons with age/ profession/
connection to each other and interests: |
|
|
| DESIRED
OPTIONS |
Preferred destinations:
Possible dates and length of stay:
(days, weeks, months) between
and
|
| |
| DETAILS
OF THE HOME OFFERED FOR EXCHANGE |
| |
Location: |
|
house |
city-centre |
|
bungalow/villa |
urban |
|
cottage |
suburban |
|
appartment/flat |
rural |
|
holiday-home |
seaside |
| or:
|
lakeside |
| approx. floor area in sm:
other floors:
|
mountains |
garden in sm:
garage
parking-place in a distance of:
number of bedrooms:
number of bathrooms:
(a single toilet is a half bathroom)
Max. number of persons my house can comfortably accomodate:
In my house you will find and I can offer the use of: |
|
usual domestic appliances |
central heating |
|
access for disabled |
fire-place |
|
garden |
balcony |
|
garage |
terrace |
|
dish-washer |
television |
|
washing machine |
radio/stereo |
|
drier |
vcr |
|
micro-wave |
phone |
My house is in walking distance to:
restaurants
local shopping
sport-facilities
culture possibilities
play garden
public swimming-pool |
Nearby you can find:
woods
river
sea-beach
public swimming pool or
The nearest bigger city is:
at
km, to be reached by
|
|
Type of closest public transport is:
bus at
m/km
tram at
m/km
train at
m/km
I can also offer the use of:
car
bicycles
boat
exchange of car other:
|
| SUMMARY (please add in your own
words information which might be of interest) |
|
|
| |
| MISCELLAENANEAS: |
In my house pet-care is desired:
not
well for
In my house children are welcome :
well
not only above the age of
In my house smoking is allowed :
well
not, because
To reach my house you will need a car :
well
not, because
|
In your house I can offer pet-care :
well not, only for
,because
I am smoker
well
not
I am smoker, but shall respect a wish of no smoking in your house
Your house has to be reached by public transport :
not
well, because
I have done home-exchanges before :
not
well
times, in
References are possible :
not
well
|
| I heard of Privak through:
|
I do
not
well agree with the placing of this application on the web-site
of PRIVAK
I do
not
well agree with the placing of a photo of my house on this web-site.
|
| I hereby certify that all information
in this application is accurate. I have been taken notice that once
an exchange has been arranged with the help of PRIVAK an additional
fee of € 100,-- for international destinations is due.
|
| Date:
|
|
|
We like to receive this form filled in completely.
At the moment we have received this as well as your introduction-fee
in the amount of € 30,-- to remit on Postbanknummer 3501509
in the name of PRIVAK, we shall send you a confirmation with your
number in our file. We friendly ask you to report any changes in
situation or wishes a.s.a.p. to us.
PRIVAK IS THE AGENCY WITH A PERSONAL TOUCH !!! |
