Church Information Form

Please complete the form below

"*" indicates required fields

Legal Name of Church*

Known / Common Name of Church if different than above

Lead Pastor*

First Last

Church Employer Identification Number (EIN)

Needed if the church is its own society or formed as an independent church plant.

Mailing Address*

Street Address Address Line 2 City State ZIP Code

Mailing Address is ...*

Physical Church Address where services are held*

Street Address Address Line 2 City State ZIP Code

Church Phone #*

Church Website

Church Email*

Date of First Worship Service (for new church plants or date of first FM service for newly affiliated churches)

Please list other pastors of your church

Please upload the church's proof of insurance

Max. file size: 100 MB.