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First name:
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Last name:
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Email:
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Yes
No
I am currently employed or I receive recurring income regularly.
I make at least $1000 per month.
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1 week
2 week
3 week
4 week
1month
3 month
6 month
1 year+
How long have you held your checking account.
No
Yes
Have you had any over drafts in the last 60 days.
Drafts
1
2
3
4
5+
how many over drafts in the last 60 days.
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