The entire questionnaire must be completed to be processed!

Church Legal Name:

Incorporated Name:

Number of Years Incorporated:

State in Which Incorporated:

Address:

City:

State:

ZIP Code:

Church Phone Number:

Church Fax Number:

Church E-Mail Address:

Age of Church:

Denomination Affiliation:

Denomination Phone Number:

Denomination Contact:

Senior Reverend:

With Church Since:

Home Phone Number:

Cell Phone Number:

Guarantor Name:

Home Address:

City:

State:

Zip:

Who Makes Business/Financial Decisions (Pastor, committee, etc.)?:

Contact (if other than Reverend):

Phone:

Equipment Cost:

Anticipated Date of Delivery:

Equipment Description: