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I / We would be interested to enroll for the Dynamic Advertisement Service on the Estate Agents Association of India website www.eaaionline.com .

I / we am / are c Member/s c Non-Member/s of the Estate Agents Association of India.

Profile Details
Name : ( Mr. / Mrs. / Miss ) …………………………………………………………………………………..
Company : ………………………………………………………………………………………………………………
Address : ……………………………………………………………………………………………………………..…
…………………………………………………………………………………………………………………………………
Tel No. : 1. …………………… 2. …………………… 3. …………………... Fax : ……………………
Mobile : ………………………………………….. Pager : …………………………………………
E-mail : …………………………………………… Website : ………………………………………………..

0 Basic (2 Advertisements) 0 Additional Advertisements : Number required ………..

0 Bold 0 Stars : Number required ……….. ( 1 to 7 )

Second Profile Name : ( Mr. / Mrs. / Miss ) ………………………………………………………………

0 Additional Profiles : Number required ………..

1. Name : ( Mr. / Mrs. / Miss ) ……………………………………………………………………………….
2. Name : ( Mr. / Mrs. / Miss ) ……………………………………………………………………………….

Enclosed Rs. …………….. by Cash / Cheque / DD drawn on the name of " Eaaionline "
Details incase of Cheque / DD :
No. ………………. Dated ……………….. Bank…………………………………………………….
Branch ………………………………………………………… City : ……………………………….

_________________________                 Date : ……………………………
              Signature

( One identity size photo to be attached of each of the persons whose names are listed as Profiles.)