FormPiper

The Puppy Store Vineyard

Purchase

Estimated Purchase Amount

Reference name (1)

Phone number (1)

Relationship to you (1)

Reference name (2)

Phone number (2)

Relationship to you (2)

Customer

First name

Middle initial

Last name

Street number

Street name

Apt/suite

Zip code

City

State

If Form Piper is sending info to apply for financing be sure to ask for all financial disclosure documents

Identification

Date of birth

Social security number

ID type

Marital Status

ID number

State Issued

Mobile phone

Home phone

E-mail

If Form Piper is sending info to apply for financing be sure to ask for all financial disclosure documents

Housing

Rent or own

Resident type

Years at address

Months at address

Monthly rent/mort payment

Move-in Date

If Form Piper is sending info to apply for financing be sure to ask for all financial disclosure documents

Banking

Bank Type?

Bank Name

Bank Account Number

Bank Routing Number

Card Number

Card Expiration

This is optional, but is encouraged as it speeds up the process. If you do not feel comfortable providing this information, an associate will contact you and ask for this information.

Employment

Employer name

Employment status

Employer position

Employee Start Date (MM/YYYY)

Time with employer years

Time at employer months

Employer phone

Employer address

Employer city

Employer state

Employer zip code

Net monthly income

Gross monthly income

Is this a seasonal job?

Is the season currently active?

Part/Full Time

Time with previous employer years

Time at previous employer months

If Form Piper is sending info to apply for financing be sure to ask for all financial disclosure documents

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