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Lender Information Request
I would like to be contacted by a representative from:
*
Five Star Bank
Bank of America
Citizens Bank
ESL FCU
KeyBank, NA
M&T Bank
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*
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Last
Preferred contact method:
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Confidential Demographics
This data is reported in groups to our funders, which keeps our program running. However, none of your personal information is connected with this information.
Age Range
Under 30
31-44
45-59
60-74
75+
prefer not to say
Income Range
Under 35,000
35,000 - 49,999
50,000 - 74,999
75,000 - 99,999
100,000+
prefer not to say
Household Size
1
2
3
4
5
6
7
8
9
10
11
12
prefer not to say
Number of children under 18
0
1
2
3
4
5
6
7
8
9
10
11
12
prefer not to say
Gender
M
F
Other
prefer not to say
Race/Ethnicity
White
Black/African American
Asian
Mixed-race
Native American
Other
prefer not to say
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