Shoe Discount Application
Please make sure to fill out this application completely and submit it afterwards in order to be eligible for the Shoe Discount Program.
Personal Information
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
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Household and Income Information
Size of Household
*
"Household" includes all individuals related by birth, marriage, or adoption who live together (including yourself.) This may also include extended family members such as grandparents, grandchildren, aunts, or uncles residing in the same household.
Estimated Annual Income
*
Estimate of income for your household as a whole. This includes employment wages or salaries, but also other sources of income, such as unemployment or workers compensation, retirement, or child support.
Proof of Income
*
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How did you hear about Dayton Has Sole?
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