Data partner Easy Nuts: Authorization form

Name Estate Agent Amstel Property Agency

First name: Ciara Surname: Dunne
Tel nr: 020-5616311 Chamber of Commerce Nr. 34275484
Email address: info@amstel-property.com

Data resident:

First name: Surname:

Sex: Male/Female Language: Dutch/English
Date of Birth: Tel nr:
IBAN nr: Nr of residents:

Property Details:

Address:
Postal code:
City:

Type of property: apartment townhouse corner house detached house

Meter Readings:

Electricity I kWh
Electricity II kWh
Gas m3
Water m3
 Yes, my broker may process and request utility subscriptions on the Easy Nuts platform.
Yes, I am aware that I have 14 days of reflection on the products which I choose.
Yes, please sign me up to the local water company.
Yes, I agree to the automatic incasso of the above products.
Yes, I agree that Easy Nuts can make changes to energy, internet and water.
Yes, please remind me when my contract expires again.
Yes, I agree with the notes and conditions and I would like to receive them by mail.

Full Name:
Date:
Signature: