Survey- Proposed African Diaspora Federal Credit Union
    Return Completed Survey to 1425 Ferguson Avenue, Saint Louis, MO. 63133 USA with your

    First Name* Last Name*

    Address* City* State* Zip Code*

    Tel#* Email

    1. Are you interested in joining the Proposed African Diaspora Federal Credit Union within two years of it being open?
      If NO, please answer question 2. Briefly explain why not in question 12 and return the survey to the above address.
    2. Are you currently a member at a credit union or customer at a bank? *

      Member at a Credit UnionCustomer at a BankOther

      If the other box is checked, Please explain

    3. Please indicate which of the following products and services are Desired or Necessary for you to join the credit union (use a D for Desired and N for Necessary):
      Savings/Shares Loans Other Services Other Services
      Savings: Signature: Over Draft: Money Order:
      Checking: New Vehicle: Debit Card: Cashier Checks:
      Shares Certificate: Used Vehicle: ATM Card: Direct Deposit:
      IRA: First Mortgage: Online Banking: Wire Transfer:
      Business Checking: Home Equity: Online Bill Pay: Notary:
      Other: Credit Card: Financial Counseling: Other:
      Other: Telephone Banking:
      If any of the "Other" boxes are checked, please explain
    4. Would you be willing to pledge an initial donation to support the startup expenses in the credit union? * YesNo If yes, how much would you be willing to donate?
      $250 $500 $750 $1000 Other
    5. Would you be interested in making regular deposit (such as payroll deposit) in the credit union? * YesNo If yes, how much would you deposit monthly? $

      If you checked any of the "Savings/Shares" boxes above, please complete following question as applicable.

    6. Which of the following average balances for the share account would you be able to keep in the credit union?
      Share Type $0- $300 $301- $500 $501- $1000 $1001- $2000 $2001- $2500 $2501- $3000 Over $3000
      Savings
      Checking
      Share Certificate
      IRA
      Business Checking
      Other
    7. Which of the following average balance for each share certificate term (i.e. Maturity date) would you be able to keep in the credit union?
      Share Certificate Type $0- $300 $301- $500 $501- $1000 $1,001- $1500 $1501- $2000 $2001- $2500 $2501- $3000 Over $3000
      6 Months
      12 Months
      24 Months
      Over 24 Months

      If you were to acquire any of the "Loans" boxes in #3, Please complete the following question as applicable.

    8. If you were to acquire a loan in the next 12 months, which of the following ranges represent the amount you might borrow for each type of the loan you are interested in?
      9. Loan Type $0- $500 $501-$1000 $1001-$5000 $5001-$10000 Over $10000
      Signature
      New Vehicle
      Used Vehicle
      1st Mortgage
      Home Equity
      Credit Card
      Other
    9. When transacting credit union business which of the following ways would you use? Please use 1 for the most preferred way and 7 for the least preferred way
      Visit the Credit Union Office
      ATM
      Online Banking
      USPS Mail Services
      Telephone Banking
      Automated Telephone Banking
      Other, please explain
    10. Would you be interested in being a volunteer official at the credit union? * YesNo
    11. Please provide us with any other thoughts or comment you would like to share with us.


      Refer Friends (you can add multiple email addresses separated by a comma(e.g [email protected],[email protected]))

      How did you hear about us?

    Print Name*

    Signature