This questionnaire was developed to assist us in locating a suitable roommate for you in the New York City Area. Please feel free to email us any additional information which you believe would help us throughout this process.

Please fill in completely.

First Name  Last Name

E-mail  Phone Number: 

Would you consider renting an apartment yourself or with a roommate ?               Yes:  No:

Would you like to be contacted by roommates with the apartments ?                      Yes: No:

Would you like to be contacted regarding related services from our partners such as:

storage, moving services, cleaning services and furniture rentals, etc ?                 Yes: No:

Your occupation/industry:  

Your sexual orientation: (optional) Gay Lesbian  Bi Straight  

Your age:  

Your gender:  Male Female   TransFemale(MTF) TransMale(FTM)  

Do you smoke:  Yes No 

Have you used Rainbow Roommates before:  Yes: No:

If not, how did you find out about us:  

Do you have pets:  None Dog Cat 

Hobbies and interests:  

Date you wish to move:   (mm/dd/yy)

Preferred accommodation: 

Preferred neighborhoods: please check all areas of interest and review how to balance your search criteria

SoHo and Below   Chelsea                               East Village/Lower East Side 

Gramercy Park     Greenwich Village/West Village Midtown East 

Midtown West     Upper East Side                     Upper West Side

Above 130th. St. New Jersey                           Queens                         Long Island

Brooklyn             Bronx                                   Staten Island                 Westchester

                            ALL AVAILABLE AREAS

Maximum monthly rent: $ You should spend no more than 1/3 of your total income on rent.

Your roommate preferences: 

Gender Preference

Pet Preference 

Smoking Preference: 

Please list one personal/professional reference: (optional)

Reference Name 

Reference Occupation:

Reference Phone Number  


Additional Requirements:
Please add your comments or any further details concerning you think would assist us in your search. (250 character max)



Listing Types:

Short Term Listings = Share for 1-6 months, with occasional possibility of extension.

Long Term Listings = Share for 6+ months.

Absentee Listings = Share with roommate who is not present in the apartment full time.


Please select the listing service you want to subscribe to ?

All Types of Listings - 15 day account: Price: $45.00

All Types of Listings - 30 day account: Price: $75.00

All Types of Listings - 90 day account: Price: $140.00



Include Contact Assistance for an additional $75.00: Yes - I want Contact Assistance

With Contact Assistance, we will work with you personally to assist you in contacting prospective roommates and help coordinate your roommate interviews.

Send listings via: 
E-mail   or   Fax   or  Phone
Note. E-mailed listings are sent as attachments in RTF format and also available in email TEXT format. Please contact us to change how you receive listings.


Your Credit / Debit Card Information: 
Please choose one:Visa   Master Card   American Express Discover
Credit Card Number     Expiration Date:  (MM/YY)
V-Code or CID (Card Identification Number):
(3 rightmost digits located on the back of Visa, Master Card  or 4 digit number located on front of American Express cards)

Billing Address

City:   State  Zip Code



1. The content of the information appearing in the listings provided by Rainbow Roommates to its client is the sole responsibility of those persons posting the information. Rainbow Roommates has no control over the information provided by potential roommates, and cannot guarantee the accuracy, integrity or quality of that information. Customers should rely on their own judgment and critical evaluation of the information provided. Rainbow Roommates will not be liable in any way for any content that may appear in its listings, including, but not limited to, for any errors, omissions, or misrepresentations, or for any lost profit, loss, or damage of any kind incurred as a result of the use, or misuse, of any information provided in such listings.  


2. Rainbow Roommates Memberships are non-refundable. Because of the nature of the information provided, service is deemed rendered once the customer has access to the first listing. You must deactivate your account via email before the term of service expires, or you will automatically be renewed every month based on your original purchase price according to the following schedule: 90-day account: automatically renewed at $17.00 every 30 days, 30-day account: automatically renewed at $25.00 every 30 days, 15-day account: automatically renewed at $35.00 every 30 days. Any charge back costs will be paid by the customer.

3. Rainbow Roommates Memberships are non-transferable. Any information provided is for customers’ personal use only. Unauthorized transfer of a Rainbow Roommates Membership will result in termination of this agreement.

4. Rainbow Roommates Memberships will be processed in the order received. The activation of a membership and receipt of your first listing will not happen automatically after signing up online. Activation may be delayed, depending on the number of applications that precede yours. However, service is deemed to commence at the time the customer has access to the first listing.


5. Rainbow Roommates is not responsible for any Internet failure or periodic downtime due to systems upgrades.


By initializing here I agree to the above disclaimer & terms of service.

       << your initials here