Independence, Inc. Rental Questionnaire  (print out and send in)

1. For what type of work will your organization use the space? 

[ ] For profit
[ ] Not-for-profit
[ ] Professional services
[ ] Direct Service
[ ]Other________________________________________________________________

2. What is your organization's mission? 
   
   _______________________________________________________________________
   
   _______________________________________________________________________
   
   
3. How much space is your organization seeking? (please consider estimated square feet, number of rooms, number of staff to accommodate, etc.)
   
   _________________________________________________________________________
   
   _________________________________________________________________________

_________________________________________________________________________

4. During what hours would you typically plan to use the space? (9 to 5, 24 hours, weekends, etc.) 
   
   _________________________________________________________________________
   
   
5. Approximately how much customer/client traffic per day would you expect during regular 
   business hours? [ ] 0-10 [ ] 10-20 [ ] 20+ 
   
   
6. Which of the following services available through Independence, Inc. would your organization be interested in utilizing?
   [ ] Reception/message services 
   [ ] Use of additional meeting space
   [ ] Internet access 
   [ ] Use of kitchen
   [ ] Multi-line phone system 
   [ ] Use of photocopier
   [ ] Office furnishing (desk, chairs, bookcases, etc.) 
   [ ] Use of postage meter
   
   
7. Will you need storage? [ ] no / [ ] yes. 
   If "yes" what type and how much. 
   
   ______________________________________________________________________
   
   
8. How long of a lease would your organization want? 
   
   ______________________________________________________________________
   
   
9. How soon would your organization need the space? 
   
   ______________________________________________________________________
   
   If you are currently in a lease, when does it expire?
   
   ______________________________________________________________________
   
   
10. What are your organization's funding sources? 
    
    ______________________________________________________________________
    
    
11. Does your current lease include utilities and maintenance? [ ] no / [ ] yes
    
    
    

Agency Name: ____________________________ 

Contact Person: __________________________

Address: ___________________________________________________ 

Phone: _______________

E-mail: __________________________________

Mail to:

Independence, Inc.
    attn: Tanya Dorf
2001 Haskell Ave.
Lawrence, KS 66046