FormPiper

The Puppy Store Vineyard

Purchase

Are you a legal citizen of the US or Canada?

Estimated Purchase Amount

Have you declared bankruptcy in the last 7 years?

Bankruptcy year

Bankruptcy State

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

ID number

ID expiration

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

If own - Property value

If own - Present Balance

Monthly rent/mort payment

Landlord/mortgage holder

Landlord/mortgage phone

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 Type?

Card Number

Card CVV

Card Expiration

Billing Zip

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

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

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

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