Order Form- Losing The Love Scorecard Please fill out the form to place your order. Type of study* One-time Recurring Requested completion date*MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Credit Union name*The full name of your Credit Union.CEO*The name of your Credit Union's CEO. First Last Contact name*The name of our contact for this project. First Last Contact phone number*The phone number of our contact for this project.Contact email*The email address of our contact for this project. Consent* I have reviewed this form and my answers, and give approval on behalf of my credit union to consent to the charges and fees as listed on this website unless otherwise discussed with Xtend for special pricing.
