| Church or
Organization Name |
____________________________________________ |
| |
|
| Account Name
(Endowment, etc.) |
____________________________________________ |
| |
|
| Mailing Address |
____________________________________________ |
| |
|
| |
____________________________________________ |
| |
|
| |
|
| Name of DIT
Contact (1) |
____________________________________________ |
| |
|
| Authorized
Signature |
____________________________________________ |
| |
|
| Telephone Number |
____________________________________________ |
| |
|
| |
|
| Name of DIT
Contact (2) |
____________________________________________ |
| |
|
| Authorized
Signature |
____________________________________________ |
| |
|
| Telephone Number |
____________________________________________ |
| |
|
| |
|
| Name of DIT
Contact (3) |
____________________________________________ |
| |
|
| Authorized
Signature |
____________________________________________ |
| |
|
| Telephone Number |
____________________________________________ |
| |
|