Au quotidien - [WASTE CARD] English form

Your civil status * Mr. Mrs.

Your name *

Your first name *

Your date of birth *

Your place of birth *

Your spouse's civil status Mr. Mrs.

Your spouse's name

Your spouse's first name

Your spouse's date of birth

Your spouse's place of birth

You are * Owners Tenants

If ‘Owners’, specify the names of the previous owners

If ‘Tenants’, give details of the owner and/or former occupier

This is your * Main residence Secondary residence (specify main address in comments)

Your address *

Your municipality *

Date of arrival in your home *

Number of people in your home *

Your telephone number *

Your e-mail

Documents to be sent (certificate of sale or purchase, etc.)

Comments or details (work in progress, card number if given by previous occupants, etc.)

Certification of information * I certify the accuracy of the information provided I certify that I have read the service regulations

Please tick the 2 boxes above and the captcha

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