* 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: