Office Rental Application

Name *

Phone *

Email *

Address

Title(s) (in regards to the service(s) you offer) *

Service(s) (what you would be offering at the VHHC) *

Experience (how long have you been practicing) *

How many clients do you currently serve approximately? *

What length(s) of time are your sessions? *

What is your hourly rate? *

About you (tell us a little about yourself) *

Desired schedule (the days and times of the week you hope to see clients) *

Desired rate plan Desired rate plan $200/mo :: 6hrs/wk $250/mo :: 8hrs/wk $300/mo :: 10hrs/wk $350/mo :: 12hrs/wk $400/mo :: 14hrs/wk $500/mo :: 18hrs/wk $650/mo :: 24hrs/wk $800/mo :: 32hrs/wk

Desired add-ons Desired add-ons BioMat ~ $100/mo Linens ~ $15/mo Storage ~ $10/mo Printer ~ $10/mo Complete package (all add-ons) ~ $120/mo Parking Pass ~ $50 (one-time fee)

Have you rented a commercial space before? * Have you rented a commercial space before? * Yes No

When do you hope to begin renting? *