Debt Free Banking Form – Pink Financial Bank

Official pāyZero® Debt Free Banking™ Application

Thank you for your interest in Debt-Free Banking™. Step 1: Please fill in the application below. After you complete the application, you will be asked to move to Step 2: where you will be asked to place your household budget into the MyXtraMoney Margin Calculator.

Step 1 of 3

Name*
First Last
Phone*
Email*

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Where do you currently bank?*
Is that a Bank, or a Credit Union?*
Do you have Direct Deposit?*
Date of Birth*
Address*
Street Address Address Line 2 City State ZIP Code
How long have you lived at this address?*
- Less than 2 years
- More than 2 years
Previous Address*
Street Address Address Line 2 City State ZIP Code
Do you own or rent?*
- Own
- Rent
What is your monthly payment?*

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What is your employment status?*
- Employed
- Self Employed
- Student
- Unemployed
Employer Name*
Job Type*
Work Number*
Length of Employment*
Net Monthly Income*
Please enter a number greater than or equal to 3300.

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