Sourcing Made Simple

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Address2
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Date Of Birth(*)
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Race(*)
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(If Hispanic) What country were you born in:
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What languages do you speak fluently?
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Gender(*)
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Marital Status(*)
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Do you have any children in your household? If so, please enter gender and Date of Birth.

Child 1

Gender
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Date Of Birth
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Child 2

Gender
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Date Of Birth
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Child 3

Gender
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Date Of Birth
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Child 4

Gender
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Date Of Birth
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Child 5

Gender
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Date Of Birth
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Highest Education Level(*)
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What is your employment status?(*)
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What is your occupation?
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What industry do you work in?
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Do you own a home-based business?
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Annual Household Income(*)
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Primary Residence
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Residence Type
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Party Affiliation
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Who is your primary banking institution?
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Do you have a checking account?
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If so, with what institutions?
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Do you have credit accounts?
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If so, with what institutions?
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Who is your primary health insurance provider?
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Do you smoke?
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Do you own a smart phone?
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Which of the following devices do you own (check all that apply)?
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Vehicle Make & Model
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Vehicle Year
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