FINANCE INFORMATION

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* 1. Preferred Location

Rocky View

Red Deer

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* 2. Are you working with a salesperson?

Yes

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* 3. RV Interested In?

Year

Make

Model

stock #

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* 4. First Name

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* 5. Middle Name

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* 6. Last Name

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* 7. Email

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* 8. Contact Phone Number

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* 9. Date of Birth mm/dd/yyyy

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* 10. Social Security Number

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* 11. Marital Status

Married

Single

Divorced

Separated

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* 12. Present Address

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

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* 13. Do you own or rent?

Own

Rent

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* 14. Years at current residence?

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* 15. Monthly Payment?

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* 16. Balance Owing?

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* 17. Present Employment

Employer Name

Employer Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Years At Employer

Occupation

Annual Salary

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* 18. Additional Income Information

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* 19. Amount $

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* 20. Frequency

Weekly

Bi-Weekly (every 2 weeks)

Monthly

Annually

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* 21. Source

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* 22. Any Bankruptcy?

Yes

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* 23. If so when?

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* 24. Preferred Contact Method

Phone