2019 築旅-危老重建諮詢登記表
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1- 填表人姓名
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2- 待重建房屋地址: *
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3- 聯絡電話: *
填寫格式如右(範例):0932-XXX-XXX 或 02-XXXX-XXXX
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4- 通訊地址: *
5- 業主年齡 *
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6- 從何得知我們? *
(可複選)
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7- 填表人E-mail:
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8- LINE ID
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9- 填表人與委託人(地主)的關係: *
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