Bank Name­­­­­­­­­­­­­­­_____________________Account Number _______________

Account since ___________ How many checks have you bounced? ______

Are your paychecks directly deposited?                                        cYes  cNo

How many frequent flyer miles do you currently hold? __________________

With which airlines?­­­­­­­­­­­­­________________________Cash value $_________.