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*  Monsieur  Madame  Mademoiselle
Nom * Prénom *
E-Mail *
Are you Credit Agricole Nord Midi-Pyrenees customer ?

yes  no       if yes, please indicate here your account number 
 
How much time do you spend in France each year ?
 

Do you have a property in France ? yes         no
 

Your French address  

 
Postal code   Town
 

French phone number :
 
Can you precise us your favourite way to contact us ?
Often Occasionally Never
Telephone
Fax
Email
Post-Mail
 
Do you want that your advisor contact you regularly ?   yes         no
 
Are you interested by a relationship by remote management ?   yes         no
 
What is the most convenient way to contact you ? (please give us your details)
  
Personnal telephone number
Professionnal telephone number
Mobile number (phone call and SMS)
Fax number
Personnal email address
Professional email address
 
Please express your expectations and wishes :

 
 
* champs obligatoires

Confidentialité des données