APPLICATION FOR SERVICES  
HOME     
 
     
1.
First Name :
2.
Last Name :
3.
Date of Birth :
4.
State of Origin :
5.
Marital Status :
6.
No of Children :
 M   F
7.
Educational Qualification(s):
8
Membership of Professional Institutions
9
Employers Name & Address :
10.
Appointment Held :
11.
Telephone No :
12.
Home Address :
13.
Telephone No :
14
Country
15
Zip Code
16.
Name of Next of Kin :
17.
Address of Next of Kin :
18
Relationship :
19
Nature of Services Required :

  A      B      C

20
Location of Services Required :
21
Type of Dwelling Required :
22
Other Please Specify:
23
You intend to
24.
When you intend to Commence construction :
25
Project Completion : Date
  
26.
How much do you intend to spend (Realistic Price) :
27.
What attracted you to Package Homes :
28

Sponsor's Name :
29
Sponsor's Address:
30
Date
     
  Forms are to sent with a non refundable fee of Ten Thousand naira Only.  (in favour of Package Homes Int. Limited) Payments can be made to Intercontinental Bank  Limited.
   
  I hereby affirm that I have voluntarily and willfully applied to Packaged Homes to render to me their services in the area , i have specified and that information stated above is correct.
 
  		  
   
 
 

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