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First Name*
Last Name*
Email*
Confirm Email*
State of Residence*
Yes	No
Yes	No	I am currently employed or I receive recurring income regularly.
Yes	No	I have three or more outstanding payday loans.
Yes	No	I have an open and active checking account.
		How long have you held your checking account.
		How many bounced checks and overdrafts have you had in the last 30 days.