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* 1. Zip Code of Customer

* 2. What cue words, if any, did you hear that made you believe the person was Bank On eligible?

* 3. Will this consumer be approved for a Bank On account at your institution?

4. If yes to question 3, which type of account will it be?

5. If yes to question 3, are there any extenuating circumstances?
If no to question 3, please explain.

6. Do you recommend that this consumer be referred to a:

7. If they were referred to a class, which class were they referred to?

8. If one-on-one, what educational material was covered?

* 9. The client was referred by: