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1. Basic Account Information
Applicant's personal data
First name
*
:
Middle name :
Last name
*
:
Email :
Country
*
:
Select Country
India
Australia
USA
UK
Singapore
UAE
Canada
Unspecified
Address Line 1
*
:
Address Line 2 :
City
*
:
State/Provinces
*
:
Zip/Postal Code
*
:
Phone 1
*
:
Phone 2 :
2. Demographic Information
Demographic Information
Birth Date :
Gender :
Select
Male
Female
Unspecified
Height :
m
cm
Weight :
Kg
Annual Income :
Education:
Select Education
Some high school or less
High school graduate
Other post high school vocational training
Completed some college, but no degree
Associates degree
Bachelor's degree
Masters or professional degree
Doctorate degree
None of the above/Prefer not to say
Marital Status:
Select Marital Status
Single
Married
Widowed
Unknown
Number of Children :
Race:
Select
White or Caucasian (non-Hispanic)
Black or African-American
Black / African Canadian / Caribbean
Hispanic or Latino
Middle Eastern
Western European
Asian or Pacific Islander
First Nations / Métis / Innuit
American Indian or Alaska Native
Mixed Racial Background
Prefer not to answer
3. Additional Information
Additional Information
Occupation Category:
Select Category
Accountant
Administrative Assistant/Secretary
Advertising/Marketing Professional
Architect
Artist
Attorney
Builder
Carpenter
Chef
Computer Specialist
Concrete/Cement/Gypsum Contractor
Construction Worker
Consultant
Dealer/Distributor
Deck or Dock Builder
Demolition Contractor
Dentist
Draftsperson
Drywall Contractor
Educational Administrator
Electrician/Electrical Contractor
Electronics/Audio/Video Installer
Engineer
Entertainer/Performer
Equipment Operator/Worker
Facility/ Maintenance/ Property Manager
Farming/Fishing/Forestry Worker
Finanical Advisor
Fire/Police
Flooring Contractor
Food Preparation/Service Worker
Foreman/Supervisor/Project Manager
General Contractor
Government Professional
Home/Building Inspector
Grower
Health Care Administrator
Health Care Professional
Human Resource Professional
HVAC Contractor
Interior Designer
Irrigation Contractor
IT Manager/Network Administrator
Journalist
Judge
Kitchen/Bath Designer
Landscape Architect
Landscape Designer
Landscape/Nursery Contractor
Lawyer
Machine Operator/ Mechanic/Production Worker
Mason
Media/Communications Professional
Merchant/Buyer
Military
Musician
Painter (Commercial/Residential)
Personal Care/Service Worker
Physician
Planner
Plumber/Plumbing Engineer/Plumbing Contractor
Professor/Instructor of Higher Education
Property Developer
Protective Service Worker
Realtor
Religious Professional
Remodeler
Roofer
Sales Agent/Representative
Scientist/Biological/Physical/Social
Social Worker
Specification Writer
Sports Professional
Statistician
Supplier
Surveyor
Teacher/Instructor of K-12
Lab assistant
Trades Person
Transportation Operator/Worker
Travel Agent
Welder
Window/Siding/Insulation Contractor
Other
Not employed
Industry:
Select Industry
Accounting
Advertising
Agriculture/Fishing
Architecture
Automotive
Aviation
Banking/Financial
Bio-Tech
Brokerage
Carpenting/Electrical installations/VVS
Chemicals/Plastics/Rubber
Communications/Information
Computer Hardware
Computer Reseller (software/hardware)
Computer Software
Construction
Consulting
Consumer Electronics
Consumer Packaged Goods
Education
Energy/Utilities/Oil and Gas
Engineering
Environmental Services
Fashion/Apparel
Food/Beverage
Government/Public Sector
Healthcare
Hospitality/Tourism
Human Resources
Information Technology/IT
Insurance
Internet
Legal/Law
Manufacturing
Market Research
Marketing/Sales
Media/Entertainment
Military
Non Profit/Social services
Personal Services
Pharmaceuticals
Printing Publishing
Public Relations
Real Estate/Property
Retail/Wholesale trade
Security
Shipping/Distribution
Telecommunications
Transportation
Other
I don't work
Do you Own a
Car
Bike
Etc
Employment Status :
Select Status
Employed full-time
Employed part-time
Self-employed full-time
Self-employed part-time
Active military
Inactive military/Veteran
Temporarily unemployed
Full-time homemaker
Retired
Student
Disabled
Prefer not to answer
Device you Own
Laptop
PC/Desktop
Tablet
Videogame
Smartphone(Android/ios)
Traveller
International
Domestic
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