Bank on Wayne Registration Form
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Online Registration Type (
Please select One option ONLY
):
Budgeting
Youth
First Name
Last Name
Email
Phone (input 1, area code and number, no spaces or dashes):
Street Address:
County
Please select...
Wayne
Greene
Lenoir
Wilson
Johnston
Sampson
Duplin
Pitt
Other
City
State
Zip
Citizenship
Please select...
U.S. Citizen
Permanent Resident
Other
Date of Birth
Gender
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Male
Female
Other
Education Level
Please select...
Trade or Craft Certification
Some college
No Formal Schooling
Master degree
Kindergarten
High School Graduate
High School Certificate
Grade 9
Grade 8
Grade 7
Grade 6
Grade 5
Grade 4
Grade 3
Grade 2
Grade 12
Grade 11
Grade 10
Grade 1
Doctorate degree
Bachelor degree
Associate degree
Race
Please select...
White alone
Black or African American alone
American Indian and Alaska Native alone
Asian alone
Native Hawaiian and Other Pacific Islander alone
Some other race alone
Two or more races
Veteran Status
Please select...
Active Military
Active Military Family
Active Reservist
Veteran
Non-Military
Employment Status
Please select...
Disabled
Employed Full-Time
Employed Part-Time
Not in Labor Market
Retired
Unemployed
Employer
How many people live in your household?
Annual Household Income
Please select...
<$7,500
$7,501 - $15,000
$15,001 - $30,000
$30,001 - $50,000
>$50,000
Did Not Disclose
Main Sources of Income (select one)
Please select...
Salary & Wages
Disability
Child Support/Alimony
Help from Family/Friends
Day Labor
SSI (Supplemental Security Income)
Social Security
Tax Credits
TANF
Interest Dividend Payments
Other
Financial Information
To select more than one value for questions, hold down Ctrl key while selecting.
If you do not already have a checking account, would you consider opening one?
Yes
No
Already Have Account
Currently Using ChexSystems?
Yes
No
How do you pay bills?
Please select...
Checks
Money Orders
Cash
Prepaid Debit Card
Where do you cash checks?
Please select...
Bank
Check-Cashing Center
Payday Lender
Walmart
Other
How much do you pay to cash check?
$
If you do not use any banking services, why not?
How do you get paid? (select one)
Please select...
Cash
Check
Prepaid Debit Card
Direct Deposit
Online
Bank Services Being Used
Please select...
Checking Account
Savings Account
Loan
No Banking Services Used
Financial Products Used
Please select...
Debit Card
Credit Card
Certificate of Deposit
Prepaid Debit Card
Money Market Account
Stocks/Bonds
Business Loan
Home Equity Loan
Mutual Fund
Mortgage Loan
Personal Loan
Line of Credit
Financial Functions Being Used
Please select...
Use a check cashing service
Buy a money order
Use a wire transfer
Get a payday loan
Got to a pawnshop
Use a rent-to-own service
Use an installment plan/lay-away
Get a credit card advance
Bounce a check or overdraw
Borrow money from friends/family
Borrow money from employer
How did you hear about Bank on Wayne?
Please select...
Advertisement
Partner Referral
Phone Inquiry
Web
Word of mouth
Other
Other
Referral Partner:
Please select...
BB&T
City of Goldsboro
Crescom Bank
Delta Sigma Theta Sorority
Department of Social Services
First Citizens Bank
Habitat for Humanity
Housing Authority City of Goldsboro-Staff
Housing Authority of the City of Goldsboro--Jobs Plus
Housing Authority of the City of Goldsboro--Ross
KS Bank
MPI – Prisoner Reentry Program
National Literacy Directory
NC Works
North Carolina Federal Credit Union
NOVA
Peggy M. Seegars Senior Center
PNC Bank
Read Wayne Program
Salvation Army--Life Skills
Salvation Army--Rapid Rehoming
Seymour Johnson Air Force Base
Society of St. Vincent de Paul
Southern Bank
State Employees Credit Union
Title V Program
Union Bank
United Way – Volunteer Wayne
University of Mount Olive
Veterans Services
WAGES-CSBG
WAGES-Parent Training
WATCH
Wayne Community College--Basic Skills
Wayne Community College--CNC Boot Camp
Wayne Community College--Federal Work Study
Wayne Community College--WIOA
Wayne County Public Library-Goldsboro
Wayne County Public Library-Steel Memorial
Wayne Pregnancy Care Center
Wayne Uplift Resource Association
Wells Fargo
Woodforest National Bank
Motivation to Participate in Bank on Wayne
Budget
Develop Personal Budget
Reduce Personal Debt
Reduce Personal Debt
Fewer Fees
Learn More Ways to Keep Your Money (Fewer Fees)
Increase Personal Savings
Increase Personal Savings
Open a Bank Account
Open a Bank Account
Financial Knowledge
Increase Financial Knowledge
Other
Other
Other
Which Bank On Wayne Session would you like to Attend?
Online Budgeting
Online Budgeting
Online Youth
Online Youth
Module 3
Online
Literacy Connections