Residential Customer Data Form

Customer's full name *

ID Number/ Iqama

Birth date

Mobile number *

E-mail *

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

National addressCity, street, zip code, extra

Employer

Years of workLess than five yearsMore than five years

Housing typeWith familyIndividual

Do you have any current law cases regarding late payments? or non-payment?YesNo

Payment terms:3 months advance payment6 months advance paymentAnnual advance payment*Depending on payment, Terms rental value is defined

Others