Step 1 of 911%Your Sales AssociateGarrett HelzerJenn SmithJD SmithGary FarkasSelect ManufacturerKIOTILS TractorTYM TractorSelect ModelCS2210CS2410CS2510CK2510 HSTCK2610CK2610 HSTCK3510CK3510HSTCK4010CK4010 HSTDK4510DK4510 HSDK5010DK5010 HSDK5510DK5510 HSNX4510NX4510 HSTNX4510 CabNX4510 HST CabNX5010NX5010 HSTNX5010 CabNX5010 HST CabNX5510 HSTNX5510 CabNX5510 HST CabNX6010 HSTNX6010 HST CabRX6010 CabRX6010 Powershuttle CabRX6620RX6620 CabRX6620 PowershuttleRX6620 Powershuttle CabRX7320RX7320 PowershuttleRX7320 Powershuttle CabRX7320 CabRX7320 PCCPX9020PX9020PCPX9530PCPX1053PCPX1153PCSelect ModelXJ2025XJ2025HXG3025XG3025HXG3032XG3032HXG3037XG3037HXG3135XG3135HXG3140XG3140HXR3037XR3037CXR3037HXR3037HCXR3135XR3135CXR3135HXR3135HCXR4040XR4040CXR4040HXR4040HCXR4046XR4046CXR4046HCXR4046HXR4140XR4140HXR4140CXR4140HCXR4145XR4145HXR4145CXR4145HCXR4150XR4150HXR4150CXR4150HCXR4155XR4155HXR4155CXR4155HXU5055XU5055CXU5065PSXU5065CPSXU6158XU6168XU6168CXU6168CPSSelect ModelT234 HSTT254T254 HSTT354T354 HSTT354 CABT354 HST CABT394 HSTT454T454 HSTT454 CABT454 HST CABT554T554 HSTT554 CABT554 HST CABT654 CABT654 CAB PST754 CABT754 CAB PST1054 CABIf not listed above, please enter make and model below.Manufacturer*Model*Additional InfoLegacy Tractors is committed to adhering to privacy principles and requirements in compliance with all applicable laws. It is our policy to safeguard all individually identifiable information entrusted to us. Use of this information enables us to provide you with superior customer service and offer products, programs, and services that may be of interest to you. We have developed this privacy notice to explain to you our practices regarding individually identifiable information.What information does this privacy notice cover? This Privacy Notice applies to the practices of Legacy Tractors, with respect to the individually identifiable information we collect about you in connection with assisting you in obtaining financing when you use the finance application on our web site.What information do we collect when applying online for vehicle financing/pre-approved credit? If you choose to submit an application to Legacy Tractors for pre-approved credit, we will need specific personally identifiable information to assist you in obtaining financing. To process your requests for financing, we collect individually identifiable information that may include: name, address, e-mail address, telephone number, fax number and Social Security number. In addition, we collect credit-related data, such as information you provide on our loan applications or other forms (including assets, income, etc.), and information we receive from consumer reporting agencies. This information will be provided to select third party lenders or financial institutions in an attempt to assist you in securing credit.How do we use the information we collect about you? Our goal is to effectively manage your entire relationship with us, our service providers, and finance companies. To this end, we may use information about you to fulfill your requests for financing, special factory programs and related services; to respond to your inquiries about our offerings; and to offer you other products, programs, or services that we believe may be of interest to you. We sometimes use this information to communicate with you, such as to contact you about your loan account with us or to provide you with important product or service information. We will share the information we collect about you with outside companies that offer financing, e.g., vendors assisting us with servicing your accounts and products. There may be instances where we will disclose individually identifiable information as permitted by law, including, but not limited to, a response to a court order or subpoena to prevent fraud, to comply with law, and to comply with a legally permitted inquiry by a government agency. Additionally, in the event that all or any part of our dealership is sold to a third party, we may transfer individually identifiable information to the third party buyer as part of the assets of the business. How do we protect and secure our customer information? We maintain appropriate physical, electronic, and procedural safeguards that comply with federal regulations to guard your individually identifiable information. For example, we utilize segregation of duties, passwords, and have in place a detailed suite of policies covering various aspects of customer information protection. Our employees have access to customer information for authorized business purposes only and such access is based on the sensitivity of the information and our employee's need to know. Our web site databases are all secured using the latest encryption technology.How can you correct inaccuracies in your information? You can review and correct factual errors in your individually identifiable information that is maintained in our computer systems, and that we retrieve during the ordinary course of business. To do so, simply send a written request to us at the address indicated on our web site. To protect your privacy and security, we will take reasonable steps to verify your identity before granting access or making corrections.How does this privacy notice relate to your online interaction with us? Most of your online interaction with us will be through our Finance Application Web pages that are part of our larger Web site. This privacy notice applies only to your interaction with us using the online Finance Application on our Web Site. It does not apply to your interaction with any other part of the Legacy Tractors Web site. In addition, the protection of your information may not be assured when you communicate with us via e-mail as others outside of our dealership may gain access to it without proper authorization.Do We Use Cookies Online? Our site uses a standard Web browser feature or Internet http header (known as "cookies") throughout our Web pages to assist us in improving your Web experience. Cookies, by themselves, do not provide individually identifiable information unless you choose to provide this information by, for example, registering with us. Once you choose to furnish us with individually identifiable information, this information may be linked to the data stored in the cookie. We use cookies to understand the usage of our Web pages and to improve their content and offerings. We may use cookies to save your password in password-protected areas, or enable you to use shopping carts.What happens when you leave our Web pages to go to other Web pages? To improve your Web experience, and to offer you products in which you might be interested, we may provide links to other third-party sites. Because we do not control these sites, you are encouraged to review their individual privacy notices.What happens if I am no longer a customer of Legacy Tractors? If you end your customer relationship with us or become an inactive customer, we will continue to treat the information we have about you consistent with this Privacy Notice.Who do I contact if I have any questions about this notice or your privacy practices? If you have any questions or concerns about this privacy notice or our privacy practices, you may contact us by writing to:Legacy Tractors 1845 North College Fort Collins CO 80524I AGREE TO THE ABOVE PRIVACY STATEMENT. Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone*Date Of Birth*Social Security #*Housing Status*Home OwnerRentalFamilyOtherMtg Pymt or Rent*Years at Address*Email* Driver's License #*Driver's License State*Expiration Date:*Is your Home Address the same as your Mailing Address?Please Answer:*YesNoAddress* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Employment Status*EmployedUnemployedRetiredMilitarySelf EmployedStudentEmployed By*Occupation*Business Phone*Salary (Gross)*Salary Type*WeeklyBi-WeeklyMonthlyAnnualLength of Employment*Alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.Other Income (Monthly)*Source of Other Income*Legacy Tractors is committed to adhering to privacy principles and requirements in compliance with all applicable laws. It is our policy to safeguard all individually identifiable information entrusted to us. Use of this information enables us to provide you with superior customer service and offer products, programs, and services that may be of interest to you. We have developed this privacy notice to explain to you our practices regarding individually identifiable information.What information does this privacy notice cover? This Privacy Notice applies to the practices of Legacy Tractors, with respect to the individually identifiable information we collect about you in connection with assisting you in obtaining financing when you use the finance application on our web site.What information do we collect when applying online for vehicle financing/pre-approved credit? If you choose to submit an application to Legacy Tractors for pre-approved credit, we will need specific personally identifiable information to assist you in obtaining financing. To process your requests for financing, we collect individually identifiable information that may include: name, address, e-mail address, telephone number, fax number and Social Security number. In addition, we collect credit-related data, such as information you provide on our loan applications or other forms (including assets, income, etc.), and information we receive from consumer reporting agencies. This information will be provided to select third party lenders or financial institutions in an attempt to assist you in securing credit.How do we use the information we collect about you? Our goal is to effectively manage your entire relationship with us, our service providers, and finance companies. To this end, we may use information about you to fulfill your requests for financing, special factory programs and related services; to respond to your inquiries about our offerings; and to offer you other products, programs, or services that we believe may be of interest to you. We sometimes use this information to communicate with you, such as to contact you about your loan account with us or to provide you with important product or service information. We will share the information we collect about you with outside companies that offer financing, e.g., vendors assisting us with servicing your accounts and products. There may be instances where we will disclose individually identifiable information as permitted by law, including, but not limited to, a response to a court order or subpoena to prevent fraud, to comply with law, and to comply with a legally permitted inquiry by a government agency. Additionally, in the event that all or any part of our dealership is sold to a third party, we may transfer individually identifiable information to the third party buyer as part of the assets of the business. How do we protect and secure our customer information? We maintain appropriate physical, electronic, and procedural safeguards that comply with federal regulations to guard your individually identifiable information. For example, we utilize segregation of duties, passwords, and have in place a detailed suite of policies covering various aspects of customer information protection. Our employees have access to customer information for authorized business purposes only and such access is based on the sensitivity of the information and our employee's need to know. Our web site databases are all secured using the latest encryption technology.How can you correct inaccuracies in your information? You can review and correct factual errors in your individually identifiable information that is maintained in our computer systems, and that we retrieve during the ordinary course of business. To do so, simply send a written request to us at the address indicated on our web site. To protect your privacy and security, we will take reasonable steps to verify your identity before granting access or making corrections.How does this privacy notice relate to your online interaction with us? Most of your online interaction with us will be through our Finance Application Web pages that are part of our larger Web site. This privacy notice applies only to your interaction with us using the online Finance Application on our Web Site. It does not apply to your interaction with any other part of the Legacy Tractors Web site. In addition, the protection of your information may not be assured when you communicate with us via e-mail as others outside of our dealership may gain access to it without proper authorization.Do We Use Cookies Online? Our site uses a standard Web browser feature or Internet http header (known as "cookies") throughout our Web pages to assist us in improving your Web experience. Cookies, by themselves, do not provide individually identifiable information unless you choose to provide this information by, for example, registering with us. Once you choose to furnish us with individually identifiable information, this information may be linked to the data stored in the cookie. We use cookies to understand the usage of our Web pages and to improve their content and offerings. We may use cookies to save your password in password-protected areas, or enable you to use shopping carts.What happens when you leave our Web pages to go to other Web pages? To improve your Web experience, and to offer you products in which you might be interested, we may provide links to other third-party sites. Because we do not control these sites, you are encouraged to review their individual privacy notices.What happens if I am no longer a customer of Legacy Tractors? If you end your customer relationship with us or become an inactive customer, we will continue to treat the information we have about you consistent with this Privacy Notice.Who do I contact if I have any questions about this notice or your privacy practices? If you have any questions or concerns about this privacy notice or our privacy practices, you may contact us by writing to:Legacy Tractors 1845 North College Fort Collins CO 80524I AGREE TO THE ABOVE PRIVACY STATEMENT. Name* First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone*Date Of Birth*Social Security #*Housing Status*Home OwnerRentalFamilyOtherMtg Pymt or Rent*Years at Address*Email* Driver's License #*Driver's License State*Expiration Date:*Is your Home Address the same as your Mailing Address?Please Answer:*YesNoAddress* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Employment Status*EmployedUnemployedRetiredMilitarySelf EmployedStudentEmployed By*Occupation*Business Phone*Salary (Gross)*Salary Type*WeeklyBi-WeeklyMonthlyAnnualLength of Employment*Alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.Other Income (Monthly)Source of Other IncomeCAPTCHA