Shareholder info 2 07 by VbX5MT

VIEWS: 3 PAGES: 1

									      A “fill-in” Microsoft Word version of this form is available on our website, www.111hicksstreet.com
                        St. George Tower and Grill owners Corp.
                            Shareholder Contact Information
Please complete this form and leave it at the front desk for Ms. Patty Marcus, site
manager, or send the completed form by e-mail to: manager@111hicksstreet.com.
The information you provide will be maintained in the co-op’s records in case
management, the superintendent, or the board of directors needs to contact you. Thank
you for your help with this important matter.

Apt. Number:                     .




Resident Shareholder #1:
      Name:
Home Phone:         (        )           –
Work Phone:         (        )          –
 Cell Phone:       (         )          –
       e-mail:            _________________________________________
Resident Shareholder #2:
      Name:
Home Phone:         (        )           –
Work Phone:         (        )          –
 Cell Phone:       (         )          –
       e-mail:            _________________________________________
EMERGENCY CONTACT INFORMATION
    Name:
Home Phone:         (        )           –
Work Phone:         (        )          –
 Cell Phone:       (         )          –
Your relationship to this person:               ___________________________

 In case of emergency, you may also want to provide details of
 pets living in your apartment:


 Any other relevant information:

								
To top