Payment Plan Request
Personal Information
Name of Applicant
*
Prefix
First Name
Middle Name
Last Name
E-mail of Applicant
*
Home Phone number of Applicant
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Area Code
Phone Number
Cell Phone number of Appliicant
*
-
Area Code
Phone Number
Date of Birth of Applicant
*
-
Month
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Day
Year
Date
Date of Birth of Applicant
*
Please select a month
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Day
Please select a year
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Year
Social Security Number of Applicant
*
Social Security Number
Present Address of Applicant
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
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American Samoa
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eSwatini
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Other
Country
How Long at this Address?
*
Previous Address of Applicant
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How Long at this Address?
*
Name of Nearest Relative Not Living With You
*
Relative Telephone Number
*
-
Area Code
Phone Number
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Next
Additional Questions
Are there any unsatisfied judgements against you?
*
Yes
No
If yes, to whom owed?
Have you declared bankruptcy in the last ten (10) years?
*
Yes
No
If yes, where?
Have you had property foreclosed upon or given title or deed in lieu thereof in the last seven (7) years?
*
Yes
No
Are you a party to a lawsuit?
*
Yes
No
Do you have any past due obligations owed to or insured by any agency of the federal government?
*
Yes
No
Back
Next
Program Selection
These options can be changed later.
Which Board & Train Program are you interested in?
*
Basic Training ($1750)
Basic Training + Remote Collar Enhancement ($2550)
Enhanced Training ($3300)
Advanced Training ($4300)
I'm unsure
Which location would you prefer?
*
Memphis, TN
Tupelo, MS
First Available
What is your requested drop-off date?
*
-
Month
-
Day
Year
Date
For how many months would you like to spread out your payments?
*
3 months
6 months
9 months
12 months
Back
Next
Certification
I will establish a payment plan and valid payment source in Invoiced. My payments will be withdrawn automatically from my payment source. If for any reason my payment should be declined, I will access my Invoiced account and update my payment source within 7 days of first unsuccessful charge on my card or bank account. I will be responsible for all costs incurred by Taming the Wild, LLC enforcing the terms, covenants and conditions of the Training Agreement, specifically including all legal costs, expenses, and reasonable attorney's fees.
*
I agree with the above statements and will uphold my obligations as outlined in my payment plan.
Everything I have stated on this Application is true and correct. I have read and agree to its terms. I understand that the Agreement will not become effective unless, and until, my Application has been approved.
*
I certify the above to be true.
Signature
Submit my application
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