Customer Application Form - Alphabait Realty

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Customer Application Form

We would like to hear from you. Please send us a message by filling out the form below and we will get back with you shortly.

Customer Name
*

Type of Customer
*

Name
*

*

Mothers Maiden Name:

Maiden Name:

Gender:
*

Date of Birth:
*

DD-MM-YYYY

Primary Number:
*

Alternative Number:

Residential Address
*

Home Address:
*

LGA of Residence:
*

City of Residence:
*

State of Residence:
*

Country of Residence:

Notable Landmark:
*

(close to Residential Address)

Email

(all correspondences would be sent here)

State of Origin:
*

Nationality:
*

Occupation:
*

Marital Status:
*

Means of Identification:
*

Employers Name & Address:
*

Name of Next of Kin:
*

Relationship:
*

Phone Number:
*

Email Address:
*

Address:
*

Are you an existing Alphabait Realty Customer?
*

Yes

No

(If known, state ID Number: If Yes, please provide details of recent subscription)

House Type:
*

Date of Subscription:
*

DD-MM-YYYY

Location:
*

Are you subscribing on behalf of someone else?
*

Yes

No

(If you are an agent or proxy, please select Yes)

Name of Project that you are interested in (if known):
*

Location:
*

House Types:

How many bedrooms:
*

1

2

3

4

5

6

Does it include maid room (BQ):
*

Yes

No

Mode of Payment
*

Outright

Instalment

Mortgage

If you are human, leave this field blank.

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