www.cityfurniture.com
Open in
urlscan Pro
52.222.236.53
Public Scan
Submitted URL: https://trk.orders.cityfurniture.com/ss/c/vLF1OcvX0Cx18vxDhdQuW0pF0aq4v5wKIVPQ-hHhmAHoQPX7ozbP16OdmbtQT86L4P3bfDHytxgtWipymkaLImdO7HT...
Effective URL: https://www.cityfurniture.com/prescreen?c=eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJjdXN0b21lcklkIjoxMDU4OTUyLCJpYXQiOjE2NTY5MzM...
Submission: On July 06 via manual from US — Scanned from DE
Effective URL: https://www.cityfurniture.com/prescreen?c=eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJjdXN0b21lcklkIjoxMDU4OTUyLCJpYXQiOjE2NTY5MzM...
Submission: On July 06 via manual from US — Scanned from DE
Form analysis 1 forms found in the DOM
<form>
<p>Drivers License</p>
<div class="PrescreenForm_prescreen-form-row__3SeRk">
<div class="PrescreenForm_form-group__3zO3w PrescreenForm_driver-license-form-group__3XtRl"><label for="driver-license">Driver License <span class="astrict">*</span></label>
<div id="driver-license" class="PrescreenForm_form-field__2E7w6"><iframe title="Secure text input frame"
src="https://js.verygoodvault.com/vgs-collect/2.1.0/lib/index.html?createdAt=1657120015321&env=bGl2ZQ%3D%3D&fieldId=randomId60029269307020413304&formId=randomId6023957667205812605&maxLength=22&name=driver_license&tnt=dG50MGtscHd6aWI%3D&type=text&validations=required&vgsCollectSessionId=e8c44304-b04f-4c10-a1e1-f2a710dffe56"
frameborder="0" scrolling="0" allowtransparency="true" id="randomId60029269307020413304"></iframe></div>
</div>
<div class="PrescreenForm_form-group__3zO3w PrescreenForm_issuing_state-form-group__2nztk"><label for="issuing_state">Issue State <span>*</span></label>
<div id="issuing_state" class="PrescreenForm_form-field__2E7w6"><iframe title="Secure dropdown input frame"
src="https://js.verygoodvault.com/vgs-collect/2.1.0/lib/index.html?createdAt=1657120015323&env=bGl2ZQ%3D%3D&fieldId=randomId6022869324713506933&formId=randomId6023957667205812605&name=issuing_state&placeholder=State&tnt=dG50MGtscHd6aWI%3D&type=dropdown&validations=required&vgsCollectSessionId=e8c44304-b04f-4c10-a1e1-f2a710dffe56"
frameborder="0" scrolling="0" allowtransparency="true" id="randomId6022869324713506933"></iframe></div>
</div>
<div class="PrescreenForm_form-group__3zO3w PrescreenForm_license_exp-form-group__3ToKC"><label for="license-expiration-month">Expiration Date<span>*</span></label>
<div style="flex-direction:row;display:flex">
<div id="license-expiration-month" class="PrescreenForm_form-field__2E7w6"><iframe title="Secure dropdown input frame"
src="https://js.verygoodvault.com/vgs-collect/2.1.0/lib/index.html?createdAt=1657120015324&env=bGl2ZQ%3D%3D&fieldId=randomId605781365232347386&formId=randomId6023957667205812605&name=license_exp_month&tnt=dG50MGtscHd6aWI%3D&type=dropdown&validations=required&vgsCollectSessionId=e8c44304-b04f-4c10-a1e1-f2a710dffe56"
frameborder="0" scrolling="0" allowtransparency="true" id="randomId605781365232347386"></iframe></div>
<div id="license-expiration-year" class="PrescreenForm_form-field__2E7w6"><iframe title="Secure dropdown input frame"
src="https://js.verygoodvault.com/vgs-collect/2.1.0/lib/index.html?createdAt=1657120015325&env=bGl2ZQ%3D%3D&fieldId=randomId604558907571453368&formId=randomId6023957667205812605&name=license_exp_year&tnt=dG50MGtscHd6aWI%3D&type=dropdown&validations=required&vgsCollectSessionId=e8c44304-b04f-4c10-a1e1-f2a710dffe56"
frameborder="0" scrolling="0" allowtransparency="true" id="randomId604558907571453368"></iframe></div>
</div>
</div>
<div class="PrescreenForm_form-group__3zO3w PrescreenForm_first-row-spacer-form-group__1VGlz"></div>
</div>
<p>Personal Details</p>
<div class="PrescreenForm_prescreen-form-row__3SeRk">
<div class="PrescreenForm_form-group__3zO3w PrescreenForm_first-name-form-group__1tbAc"><label for="first-name">First Name <span>*</span></label>
<div id="first-name" class="PrescreenForm_form-field__2E7w6"><iframe title="Secure text input frame"
src="https://js.verygoodvault.com/vgs-collect/2.1.0/lib/index.html?createdAt=1657120015326&defaultValue=ALEXANDER&env=bGl2ZQ%3D%3D&fieldId=randomId6005386792751910341&formId=randomId6023957667205812605&name=first_name&tnt=dG50MGtscHd6aWI%3D&type=text&validations=required&vgsCollectSessionId=e8c44304-b04f-4c10-a1e1-f2a710dffe56"
frameborder="0" scrolling="0" allowtransparency="true" id="randomId6005386792751910341"></iframe></div>
</div>
<div class="PrescreenForm_form-group__3zO3w PrescreenForm_middle-initial-form-group__2LTsc"><label for="middle-initial">Middle Initial</label>
<div id="middle-initial" class="PrescreenForm_form-field__2E7w6"><iframe title="Secure text input frame"
src="https://js.verygoodvault.com/vgs-collect/2.1.0/lib/index.html?createdAt=1657120015327&env=bGl2ZQ%3D%3D&fieldId=randomId607458536362091148&formId=randomId6023957667205812605&name=middle_initial&tnt=dG50MGtscHd6aWI%3D&type=text&vgsCollectSessionId=e8c44304-b04f-4c10-a1e1-f2a710dffe56"
frameborder="0" scrolling="0" allowtransparency="true" id="randomId607458536362091148"></iframe></div>
</div>
<div class="PrescreenForm_form-group__3zO3w PrescreenForm_last-name-form-group__3diUE"><label for="last-name">Last Name <span>*</span></label>
<div id="last-name" class="PrescreenForm_form-field__2E7w6"><iframe title="Secure text input frame"
src="https://js.verygoodvault.com/vgs-collect/2.1.0/lib/index.html?createdAt=1657120015328&defaultValue=MUCHNIK&env=bGl2ZQ%3D%3D&fieldId=randomId605199382557202592&formId=randomId6023957667205812605&name=last_name&tnt=dG50MGtscHd6aWI%3D&type=text&validations=required&vgsCollectSessionId=e8c44304-b04f-4c10-a1e1-f2a710dffe56"
frameborder="0" scrolling="0" allowtransparency="true" id="randomId605199382557202592"></iframe></div>
</div>
<div class="PrescreenForm_form-group__3zO3w PrescreenForm_home-phone-form-group__qYS2F"><label for="home-phone">Home Phone Number <span>*</span></label>
<div id="home-phone" class="PrescreenForm_form-field__2E7w6"><iframe title="Secure text input frame"
src="https://js.verygoodvault.com/vgs-collect/2.1.0/lib/index.html?createdAt=1657120015329&env=bGl2ZQ%3D%3D&fieldId=randomId603815099421195818&formId=randomId6023957667205812605&name=home_phone&tnt=dG50MGtscHd6aWI%3D&type=text&validations=required&vgsCollectSessionId=e8c44304-b04f-4c10-a1e1-f2a710dffe56"
frameborder="0" scrolling="0" allowtransparency="true" id="randomId603815099421195818"></iframe></div>
</div>
<div class="PrescreenForm_form-group__3zO3w PrescreenForm_work-phone-form-group__luByj"><label for="work-phone">Work Phone Number <span>*</span></label>
<div id="work-phone" class="PrescreenForm_form-field__2E7w6"><iframe title="Secure text input frame"
src="https://js.verygoodvault.com/vgs-collect/2.1.0/lib/index.html?createdAt=1657120015329&env=bGl2ZQ%3D%3D&fieldId=randomId6008372699556523933&formId=randomId6023957667205812605&name=work_phone&tnt=dG50MGtscHd6aWI%3D&type=text&validations=required&vgsCollectSessionId=e8c44304-b04f-4c10-a1e1-f2a710dffe56"
frameborder="0" scrolling="0" allowtransparency="true" id="randomId6008372699556523933"></iframe></div>
</div>
<div class="PrescreenForm_form-group__3zO3w PrescreenForm_mobile-phone-form-group__27jHZ"><label for="mobile-phone">Mobile Number</label>
<div id="mobile-phone" class="PrescreenForm_form-field__2E7w6"><iframe title="Secure text input frame"
src="https://js.verygoodvault.com/vgs-collect/2.1.0/lib/index.html?createdAt=1657120015330&env=bGl2ZQ%3D%3D&fieldId=randomId601012895615634044&formId=randomId6023957667205812605&name=mobile_phone&tnt=dG50MGtscHd6aWI%3D&type=text&vgsCollectSessionId=e8c44304-b04f-4c10-a1e1-f2a710dffe56"
frameborder="0" scrolling="0" allowtransparency="true" id="randomId601012895615634044"></iframe></div>
</div>
</div>
<div class="PrescreenForm_prescreen-form-row__3SeRk">
<div class="PrescreenForm_form-group__3zO3w PrescreenForm_address-form-group__fNO-P"><label for="address">Address <span>*</span></label>
<div id="address" class="PrescreenForm_form-field__2E7w6"><iframe title="Secure text input frame"
src="https://js.verygoodvault.com/vgs-collect/2.1.0/lib/index.html?createdAt=1657120015331&defaultValue=20931%20SAN%20SIMEON%20WAY%20APT%20212&env=bGl2ZQ%3D%3D&fieldId=randomId608426532574106089&formId=randomId6023957667205812605&maxLength=22&name=address&tnt=dG50MGtscHd6aWI%3D&type=text&validations=required&vgsCollectSessionId=e8c44304-b04f-4c10-a1e1-f2a710dffe56"
frameborder="0" scrolling="0" allowtransparency="true" id="randomId608426532574106089"></iframe></div>
</div>
<div class="PrescreenForm_form-group__3zO3w PrescreenForm_state-form-group__1WJhL"><label for="state">State <span>*</span></label>
<div id="state" class="PrescreenForm_form-field__2E7w6"><iframe title="Secure dropdown input frame"
src="https://js.verygoodvault.com/vgs-collect/2.1.0/lib/index.html?createdAt=1657120015332&defaultValue=FL&env=bGl2ZQ%3D%3D&fieldId=randomId607603107751162839&formId=randomId6023957667205812605&name=state&placeholder=State&tnt=dG50MGtscHd6aWI%3D&type=dropdown&validations=required&vgsCollectSessionId=e8c44304-b04f-4c10-a1e1-f2a710dffe56"
frameborder="0" scrolling="0" allowtransparency="true" id="randomId607603107751162839"></iframe></div>
</div>
<div class="PrescreenForm_form-group__3zO3w PrescreenForm_city-form-group__ipa5g"><label for="city">City <span>*</span></label>
<div id="city" class="PrescreenForm_form-field__2E7w6"><iframe title="Secure text input frame"
src="https://js.verygoodvault.com/vgs-collect/2.1.0/lib/index.html?createdAt=1657120015332&defaultValue=MIAMI&env=bGl2ZQ%3D%3D&fieldId=randomId6018779982860730615&formId=randomId6023957667205812605&name=city&tnt=dG50MGtscHd6aWI%3D&type=text&validations=required&vgsCollectSessionId=e8c44304-b04f-4c10-a1e1-f2a710dffe56"
frameborder="0" scrolling="0" allowtransparency="true" id="randomId6018779982860730615"></iframe></div>
</div>
</div>
<div class="PrescreenForm_prescreen-form-row__3SeRk">
<div class="PrescreenForm_form-group__3zO3w PrescreenForm_zip-form-group__3xvD8"><label for="zip">Zip Code <span>*</span></label>
<div id="zip" class="PrescreenForm_form-field__2E7w6"><iframe title="Secure zip code input frame"
src="https://js.verygoodvault.com/vgs-collect/2.1.0/lib/index.html?createdAt=1657120015333&env=bGl2ZQ%3D%3D&fieldId=randomId6045991558164929836&formId=randomId6023957667205812605&name=zip&tnt=dG50MGtscHd6aWI%3D&type=zip-code&validations=required&vgsCollectSessionId=e8c44304-b04f-4c10-a1e1-f2a710dffe56"
frameborder="0" scrolling="0" allowtransparency="true" id="randomId6045991558164929836"></iframe></div>
</div>
<div class="PrescreenForm_form-group__3zO3w PrescreenForm_present-address-form-group__n1sVk"><label for="present-addres-year">Time at Present Address<!-- --> <span>*</span></label>
<div style="flex-direction:row;display:flex">
<div id="present-address-year" class="PrescreenForm_form-field__2E7w6"><iframe title="Secure dropdown input frame"
src="https://js.verygoodvault.com/vgs-collect/2.1.0/lib/index.html?autoComplete=email&createdAt=1657120015333&env=bGl2ZQ%3D%3D&fieldId=randomId606182849239147019&formId=randomId6023957667205812605&name=present_address_year&tnt=dG50MGtscHd6aWI%3D&type=dropdown&validations=required&vgsCollectSessionId=e8c44304-b04f-4c10-a1e1-f2a710dffe56"
frameborder="0" scrolling="0" allowtransparency="true" id="randomId606182849239147019"></iframe></div>
<div id="present-address-month" class="PrescreenForm_form-field__2E7w6"><iframe title="Secure dropdown input frame"
src="https://js.verygoodvault.com/vgs-collect/2.1.0/lib/index.html?createdAt=1657120015334&env=bGl2ZQ%3D%3D&fieldId=randomId606082491205537472&formId=randomId6023957667205812605&name=present_address_month&tnt=dG50MGtscHd6aWI%3D&type=dropdown&validations=required&vgsCollectSessionId=e8c44304-b04f-4c10-a1e1-f2a710dffe56"
frameborder="0" scrolling="0" allowtransparency="true" id="randomId606082491205537472"></iframe></div>
</div>
</div>
<div class="PrescreenForm_form-group__3zO3w PrescreenForm_email-form-group__1ua90"><label for="email">Email <span>*</span></label>
<div id="email" class="PrescreenForm_form-field__2E7w6"><iframe title="Secure text input frame"
src="https://js.verygoodvault.com/vgs-collect/2.1.0/lib/index.html?createdAt=1657120015343&env=bGl2ZQ%3D%3D&fieldId=randomId6039436708167744206&formId=randomId6023957667205812605&maxLength=45&name=email&tnt=dG50MGtscHd6aWI%3D&type=text&validations=required&validations=%2F(%3F%3A%5Ba-z0-9!%23%24%25%26'*%2B%2F%3D%3F%5E_%60%7B%7C%7D~-%5D%2B(%3F%3A%5C.%5Ba-z0-9!%23%24%25%26'*%2B%2F%3D%3F%5E_%60%7B%7C%7D~-%5D%2B)*%7C%22(%3F%3A%5B%5Cx01-%5Cx08%5Cx0b%5Cx0c%5Cx0e-%5Cx1f%5Cx21%5Cx23-%5Cx5b%5Cx5d-%5Cx7f%5D%7C%5C%5C%5B%5Cx01-%5Cx09%5Cx0b%5Cx0c%5Cx0e-%5Cx7f%5D)*%22)%40(%3F%3A(%3F%3A%5Ba-z0-9%5D(%3F%3A%5Ba-z0-9-%5D*%5Ba-z0-9%5D)%3F%5C.)%2B%5Ba-z0-9%5D(%3F%3A%5Ba-z0-9-%5D*%5Ba-z0-9%5D)%3F%7C%5C%5B(%3F%3A(%3F%3A25%5B0-5%5D%7C2%5B0-4%5D%5B0-9%5D%7C%5B01%5D%3F%5B0-9%5D%5B0-9%5D%3F)%5C.)%7B3%7D(%3F%3A25%5B0-5%5D%7C2%5B0-4%5D%5B0-9%5D%7C%5B01%5D%3F%5B0-9%5D%5B0-9%5D%3F%7C%5Ba-z0-9-%5D*%5Ba-z0-9%5D%3A(%3F%3A%5B%5Cx01-%5Cx08%5Cx0b%5Cx0c%5Cx0e-%5Cx1f%5Cx21-%5Cx5a%5Cx53-%5Cx7f%5D%7C%5C%5C%5B%5Cx01-%5Cx09%5Cx0b%5Cx0c%5Cx0e-%5Cx7f%5D)%2B)%5C%5D)%2F&vgsCollectSessionId=e8c44304-b04f-4c10-a1e1-f2a710dffe56"
frameborder="0" scrolling="0" allowtransparency="true" id="randomId6039436708167744206"></iframe></div>
</div>
<div class="PrescreenForm_form-group__3zO3w PrescreenForm_dob-form-group__324Db"><label for="dob_month">Date of Birth <span>*</span></label>
<div style="flex-direction:row;display:flex">
<div id="dob_month" class="PrescreenForm_form-field__2E7w6"><iframe title="Secure dropdown input frame"
src="https://js.verygoodvault.com/vgs-collect/2.1.0/lib/index.html?createdAt=1657120015340&env=bGl2ZQ%3D%3D&fieldId=randomId603568304025846145&formId=randomId6023957667205812605&name=dob_month&tnt=dG50MGtscHd6aWI%3D&type=dropdown&validations=required&vgsCollectSessionId=e8c44304-b04f-4c10-a1e1-f2a710dffe56"
frameborder="0" scrolling="0" allowtransparency="true" id="randomId603568304025846145"></iframe></div>
<div id="dob_day" class="PrescreenForm_form-field__2E7w6"><iframe title="Secure dropdown input frame"
src="https://js.verygoodvault.com/vgs-collect/2.1.0/lib/index.html?createdAt=1657120015341&env=bGl2ZQ%3D%3D&fieldId=randomId608588341601205516&formId=randomId6023957667205812605&name=dob_day&tnt=dG50MGtscHd6aWI%3D&type=dropdown&validations=required&vgsCollectSessionId=e8c44304-b04f-4c10-a1e1-f2a710dffe56"
frameborder="0" scrolling="0" allowtransparency="true" id="randomId608588341601205516"></iframe></div>
<div id="dob_year" class="PrescreenForm_form-field__2E7w6"><iframe title="Secure dropdown input frame"
src="https://js.verygoodvault.com/vgs-collect/2.1.0/lib/index.html?createdAt=1657120015342&env=bGl2ZQ%3D%3D&fieldId=randomId6039111112272468906&formId=randomId6023957667205812605&name=dob_year&tnt=dG50MGtscHd6aWI%3D&type=dropdown&validations=required&vgsCollectSessionId=e8c44304-b04f-4c10-a1e1-f2a710dffe56"
frameborder="0" scrolling="0" allowtransparency="true" id="randomId6039111112272468906"></iframe></div>
</div>
</div>
<div class="PrescreenForm_form-group__3zO3w PrescreenForm_relative_phone-form-group__wPtyl"><label for="relative_phone">Relative's<!-- --> Phone Number<!-- --> <span>*</span></label>
<div id="relative_phone" class="PrescreenForm_form-field__2E7w6"><iframe title="Secure text input frame"
src="https://js.verygoodvault.com/vgs-collect/2.1.0/lib/index.html?createdAt=1657120015344&env=bGl2ZQ%3D%3D&fieldId=randomId609494759980484413&formId=randomId6023957667205812605&name=relative_phone&tnt=dG50MGtscHd6aWI%3D&type=text&validations=required&vgsCollectSessionId=e8c44304-b04f-4c10-a1e1-f2a710dffe56"
frameborder="0" scrolling="0" allowtransparency="true" id="randomId609494759980484413"></iframe></div>
</div>
</div>
<div class="PrescreenForm_prescreen-form-row__3SeRk">
<div class="PrescreenForm_form-group__3zO3w PrescreenForm_ssn-form-group__2A1M3"><label for="ssn">Social Security Number or ITIN<!-- --> <span>*</span></label>
<div id="ssn" class="PrescreenForm_form-field__2E7w6"><iframe title="Secure text input frame"
src="https://js.verygoodvault.com/vgs-collect/2.1.0/lib/index.html?autoFocus=true&createdAt=1657120015345&env=bGl2ZQ%3D%3D&fieldId=randomId6020968027519159338&formId=randomId6023957667205812605&name=ssn&tnt=dG50MGtscHd6aWI%3D&type=text&validations=required&vgsCollectSessionId=e8c44304-b04f-4c10-a1e1-f2a710dffe56"
frameborder="0" scrolling="0" allowtransparency="true" id="randomId6020968027519159338"></iframe></div>
</div>
<div class="PrescreenForm_form-group__3zO3w PrescreenForm_confirm_ssn-form-group__RDRqZ"><label for="confirm_ssn">Confirm Social Security Number or ITIN<!-- --> <span>*</span></label>
<div id="confirm_ssn" class="PrescreenForm_form-field__2E7w6"><iframe title="Secure text input frame"
src="https://js.verygoodvault.com/vgs-collect/2.1.0/lib/index.html?createdAt=1657120015346&env=bGl2ZQ%3D%3D&fieldId=randomId6005697867654638156&formId=randomId6023957667205812605&name=confirm_ssn&tnt=dG50MGtscHd6aWI%3D&type=text&validations=required&vgsCollectSessionId=e8c44304-b04f-4c10-a1e1-f2a710dffe56"
frameborder="0" scrolling="0" allowtransparency="true" id="randomId6005697867654638156"></iframe></div>
</div>
<div class="PrescreenForm_form-group__3zO3w PrescreenForm_home_occupancy-form-group__2P8Xl"><label for="home_occupancy">Home Occupancy <span>*</span></label>
<div id="home_occupancy" class="PrescreenForm_form-field__2E7w6"><iframe title="Secure dropdown input frame"
src="https://js.verygoodvault.com/vgs-collect/2.1.0/lib/index.html?createdAt=1657120015347&env=bGl2ZQ%3D%3D&fieldId=randomId609254039339082629&formId=randomId6023957667205812605&name=home_occupancy&tnt=dG50MGtscHd6aWI%3D&type=dropdown&validations=required&vgsCollectSessionId=e8c44304-b04f-4c10-a1e1-f2a710dffe56"
frameborder="0" scrolling="0" allowtransparency="true" id="randomId609254039339082629"></iframe></div>
</div>
<div class="PrescreenForm_form-group__3zO3w PrescreenForm_monthly_amount-form-group__81LdH"><label for="present-addres-year"><label for="monthy_amount">Monthly amount <span>*</span></label></label>
<div id="monthy_amount" class="PrescreenForm_form-field__2E7w6"><iframe title="Secure text input frame"
src="https://js.verygoodvault.com/vgs-collect/2.1.0/lib/index.html?createdAt=1657120015347&env=bGl2ZQ%3D%3D&fieldId=randomId60936364418718818&formId=randomId6023957667205812605&name=monthy_amount&tnt=dG50MGtscHd6aWI%3D&type=text&validations=required&vgsCollectSessionId=e8c44304-b04f-4c10-a1e1-f2a710dffe56"
frameborder="0" scrolling="0" allowtransparency="true" id="randomId60936364418718818"></iframe></div>
</div>
<div class="PrescreenForm_form-group__3zO3w PrescreenForm_monthly_income-form-group__3LO8y"><label for="monthly_income">Monthly income <span>*</span></label>
<div id="monthly_income" class="PrescreenForm_form-field__2E7w6"><iframe title="Secure text input frame"
src="https://js.verygoodvault.com/vgs-collect/2.1.0/lib/index.html?createdAt=1657120015348&env=bGl2ZQ%3D%3D&fieldId=randomId604000325674321126&formId=randomId6023957667205812605&name=monthly_income&tnt=dG50MGtscHd6aWI%3D&type=text&validations=required&vgsCollectSessionId=e8c44304-b04f-4c10-a1e1-f2a710dffe56"
frameborder="0" scrolling="0" allowtransparency="true" id="randomId604000325674321126"></iframe></div>
</div>
</div>
<div class="PrescreenForm_prescreen-form-row__3SeRk">
<div class="PrescreenForm_form-group__3zO3w PrescreenForm_cc_type-form-group__2ZOEH"><label for="cc_type">Credit card type <span>*</span></label>
<div id="cc_type" class="PrescreenForm_form-field__2E7w6"><iframe title="Secure dropdown input frame"
src="https://js.verygoodvault.com/vgs-collect/2.1.0/lib/index.html?createdAt=1657120015349&env=bGl2ZQ%3D%3D&fieldId=randomId6016757007093206777&formId=randomId6023957667205812605&name=cc_type&tnt=dG50MGtscHd6aWI%3D&type=dropdown&validations=required&vgsCollectSessionId=e8c44304-b04f-4c10-a1e1-f2a710dffe56"
frameborder="0" scrolling="0" allowtransparency="true" id="randomId6016757007093206777"></iframe></div>
</div>
<div class="PrescreenForm_form-group__3zO3w PrescreenForm_cc_exp-form-group__3-V2Q">
<div><label for="present-addres-year"><label for="cc_exp_month">Credit card expiration<!-- --> <span>*</span></label></label></div>
<div style="flex-direction:row;display:flex">
<div id="cc_exp_month" class="PrescreenForm_form-field__2E7w6"><iframe title="Secure dropdown input frame"
src="https://js.verygoodvault.com/vgs-collect/2.1.0/lib/index.html?createdAt=1657120015350&env=bGl2ZQ%3D%3D&fieldId=randomId606184180764791192&formId=randomId6023957667205812605&name=cc_exp_month&tnt=dG50MGtscHd6aWI%3D&type=dropdown&validations=required&vgsCollectSessionId=e8c44304-b04f-4c10-a1e1-f2a710dffe56"
frameborder="0" scrolling="0" allowtransparency="true" id="randomId606184180764791192"></iframe></div>
<div id="cc_exp_year" class="PrescreenForm_form-field__2E7w6"><iframe title="Secure dropdown input frame"
src="https://js.verygoodvault.com/vgs-collect/2.1.0/lib/index.html?createdAt=1657120015351&env=bGl2ZQ%3D%3D&fieldId=randomId609797859556972526&formId=randomId6023957667205812605&name=cc_exp_year&tnt=dG50MGtscHd6aWI%3D&type=dropdown&validations=required&vgsCollectSessionId=e8c44304-b04f-4c10-a1e1-f2a710dffe56"
frameborder="0" scrolling="0" allowtransparency="true" id="randomId609797859556972526"></iframe></div>
</div>
</div>
<div class="PrescreenForm_form-group__3zO3w PrescreenForm_employer-form-group__27WJn"><label for="employer">Employer <span>*</span></label>
<div id="employer" class="PrescreenForm_form-field__2E7w6"><iframe title="Secure text input frame"
src="https://js.verygoodvault.com/vgs-collect/2.1.0/lib/index.html?createdAt=1657120015352&env=bGl2ZQ%3D%3D&fieldId=randomId602208038997001578&formId=randomId6023957667205812605&maxLength=20&name=employer&tnt=dG50MGtscHd6aWI%3D&type=text&validations=required&vgsCollectSessionId=e8c44304-b04f-4c10-a1e1-f2a710dffe56"
frameborder="0" scrolling="0" allowtransparency="true" id="randomId602208038997001578"></iframe></div>
</div>
<div class="PrescreenForm_form-group__3zO3w PrescreenForm_time_with_employer-form-group__-VqPB"><label for="time_with_employer_month">Time with present employer<!-- --> <span>*</span></label>
<div style="flex-direction:row;display:flex">
<div id="time_with_employer_month" class="PrescreenForm_form-field__2E7w6"><iframe title="Secure dropdown input frame"
src="https://js.verygoodvault.com/vgs-collect/2.1.0/lib/index.html?createdAt=1657120015353&env=bGl2ZQ%3D%3D&fieldId=randomId6006481585780146748&formId=randomId6023957667205812605&name=time_with_employer_month&tnt=dG50MGtscHd6aWI%3D&type=dropdown&validations=required&vgsCollectSessionId=e8c44304-b04f-4c10-a1e1-f2a710dffe56"
frameborder="0" scrolling="0" allowtransparency="true" id="randomId6006481585780146748"></iframe></div>
<div id="time_with_employer_year" class="PrescreenForm_form-field__2E7w6"><iframe title="Secure dropdown input frame"
src="https://js.verygoodvault.com/vgs-collect/2.1.0/lib/index.html?createdAt=1657120015354&env=bGl2ZQ%3D%3D&fieldId=randomId60395761041275561&formId=randomId6023957667205812605&name=time_with_employer_year&tnt=dG50MGtscHd6aWI%3D&type=dropdown&validations=required&vgsCollectSessionId=e8c44304-b04f-4c10-a1e1-f2a710dffe56"
frameborder="0" scrolling="0" allowtransparency="true" id="randomId60395761041275561"></iframe></div>
</div>
</div>
<div class="PrescreenForm_form-group__3zO3w PrescreenForm_last-row-spacer-form-group__3xQ4S"></div>
</div>
</form>Text Content
1 Welcome 2 Application 3 Terms & Conditions 4 Approval & Shop HI, ALEXANDER: You have been pre-approved for $1,000.00. Instead of going back to the store location, you can accept this preapproval, at anytime, from anywhere. Fill out your information in 3 easy steps, sign and submit. Then you’ll be on your way to making your home, your dream home. Next > Drivers License Driver License * Issue State * Expiration Date* Personal Details First Name * Middle Initial Last Name * Home Phone Number * Work Phone Number * Mobile Number Address * State * City * Zip Code * Time at Present Address * Email * Date of Birth * Relative's Phone Number * Social Security Number or ITIN * Confirm Social Security Number or ITIN * Home Occupancy * Monthly amount * Monthly income * Credit card type * Credit card expiration * Employer * Time with present employer * < Prev Next >