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Contact Information:
Your Name _________________________________________________________________ Date of Application ______________
Contact Phone (
) _________________________________ Your position ___________________________________________
Your Birthdate __________ Sex _______ Marital Status ____________ Spouses Name __________________________________
Name of Ministry ____________________________________________________________________________________________
E-Mail address: _________________________________ Website _____________________________________________________
Physical Address _______________________________________________City ________________State_______ Zip___________
Mailing Address _______________________________________________City ________________State_______ Zip____________
Phone (
)__________________ How long have you been at this location? ____________ Are you Incorporated? ____________
If yes, what state? ______________ Year of Incorporation __________Tax ID # (FEIN or SSN) _____________________________
Have you prayed about being chartered with Pillar of Truth Ministries & why do you want this? ______________________________
___________________________________________________________________________________________________________
Principle Officers or Board members: (Or for Evangelistic or Outreach charters, please include references) (Church Charter requires min. of 3 Board members)