Its easy to apply and we will contact you within hours Name * First Name Last Name Email * Phone (###) ### #### Date of birth MM DD YYYY Are you in the West Midlands? * if not in the west midlands we can not currently deliver to you. Yes No What would you like to rent? Do you have a bank account? Yes No Are you employed * Yes No How long have you lived in the property? How many people are in the house hold? Is there a water inlet supply, a waste pipe and a 13 amp plug close by? Water inlet supply Waste pipe 13 Amp plug Not sure Is there a washing machine to be removed Yes No Any special requests? Do you realise the machines remain the property of Vaxlynx Ltd? * Have you read and agree to he terms and conditions on this page? * Yes Thank you!
