Germantown Avenue Crisis Ministry (GACM)

Name *

First Name

Last Name

Phone *

(###)

###

####

1. Do you have a checking and/or savings account with a financial institution? *

Check all that apply

Checking

Saving

Other

None

If you have a checking account, please answer the following set questions: A. Have you paid any overdraft fees in the past 6 months?

YES

NO

C. How do you access your account? (Check all that apply)

Smartphone

Laptop/Tablet

Computer

Visit Branch

A. If you answered "yes," How much have you paid in fees in the last 6 months?

None

Less than $100

$100 - $200

More than $200

B. If you answered "yes," How much have you paid in fees in the last 6 months?

None

Less than $100

$100 - $200

More than $200

A. If you answered "yes," when was the last time you checked your score?

Within the month

Within the year

Over a year

Never