The Puppy Store Vineyard
Purchase
Customer
Identification
Housing
Banking
Employment
Purchase
Estimated Purchase Amount
Reference name (1)
Phone number (1)
Relationship to you (1)
Spouse
Child
Parent
Grandparent
Aunt/Uncle
Other Relative
Co-worker
Friend
Other
Reference name (2)
Phone number (2)
Relationship to you (2)
Spouse
Child
Parent
Grandparent
Aunt/Uncle
Other Relative
Co-worker
Friend
Other
Customer
First name
Middle initial
Last name
Street number
Street name
Apt/suite
Zip code
City
State
Alaska
Alabama
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Identification
Date of birth
Social security number
ID type
State Drivers License
Military ID
State ID
Marital Status
Married
Single
Separated
Unknown
ID number
State Issued
Alaska
Alabama
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Mobile phone
Home phone
E-mail
Housing
Rent or own
Own Home
Rent
Other
Resident type
Home
Apartment
Condominium
Mobile Home
Other
Years at address
Months at address
Monthly rent/mort payment
Move-in Date
Banking
Bank Type?
Savings
Checking
Bank Name
Bank Account Number
Bank Routing Number
Card Number
Card Expiration
Employment
Employer name
Employment status
Employed
Self Employed
Unemployed
Student
Retired
Military
Employer position
Employee Start Date (MM/YYYY)
Time with employer years
Time at employer months
Employer phone
Employer address
Employer city
Employer state
Alaska
Alabama
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Employer zip code
Net monthly income
Gross monthly income
Is this a seasonal job?
No
Yes
Is the season currently active?
No
Yes
Part/Full Time
Part time
Full time
Time with previous employer years
Time at previous employer months