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.

Contact Us

No 75 Aminu Kano Crescent Wuse II Abuja Nigeria
info@alphabaitrealty.com

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