Customer Information Form
First name/s
Middle name/s
Last name
D:O:B
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Phone Number
Please enter a valid phone number.
Upload photo ID
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Take Photo of ID
Secondary contact information
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone number
*
Phone Number
Please enter a valid phone number.
What type of cabin are you looking for?
Rental
Purchase
Credit One Finance (this option has replaced the Lease to Own option)
Cabin size
Standard 3.8m x 2.6m
Standard 4.4m 2.6m
Double Glaze 3.8m x 2.6m
Double Glaze 4.4m x 2.6m
Double Glaze 5m x 2.6
Premium 4.4m x 2.5m
Other
Who owns the property that the cabin will be placed on
Myself
My parents
I rent
Other
If other, please explain
Do you need a WINZ quote
Yes
No
Employment
*
Full time
Part time
Unemployed
Other
Approx weekly income before tax
Company name/Employer
*
Do you agree to a credit check
*
Yes
No
Note/comments/additional information
Where did you hear about us?
*
Submit
Should be Empty: