PHOTO

Nagalakshmi Nagar, Survey No. 33 to 36, Madurai - Rajapalayam Road, T.Kunnathur,
Peraiyur Taluk, Madurai District, Pin Code - 625708.
NAGALAKSHMI NAGAR HOUSING SITE
APPLICATION FOR BOOKING
BOOKING DATE           
CUSTOMER CODE       

PHOTO
 
        CUSTOMER NAME          MR/MRS/MISS
1      

        S/O / D/O / W/O
           DOB   
        NOMINEE NAME
        

        CUSTOMER NAME          MR/MRS/MISS
2      

        S/O / D/O / W/O
           DOB   
        NOMINEE NAME
        

ADDRESS



MOB.NO. PIN CODE
PHONE NO 1 PHONE NO 2
EMAIL ID 1 EMAIL ID 2
PLOT NO SFT
TOTAL COST Rs INSTALMENT PATTERN Rs. X Months
Cheques / DD Details
S.No. DateRecpt.NoChq.No/D.DBank NameBranch NameCityAmount
1          
2           
3           
4           
5          
6          
7          
8          
9          
10          

AGENT (SIGN.)                                                       

" I have read the entire terms & conditions printed on the reverse of the application form, I have understood
the entire terms & conditions and agree to abide by the same"

CUSTOMER (SIGN.)                                                                           CUSTOMER (SIGN.)                                                     


FOR OFFICE USE

LAND REGISTERED ON                                            DOC.NO                                            PLOT NO                                          

SURVEY NO                                                              TOTAL EXT.                               

Print