Spiritual Ministry Client Intake Form

Name of Entity*

Date entity was conceived, organized, or started:*

Entity's Physical Address: (no P.O. Box)*

Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code

Entity's Phone #

Entity's County

# of Board Members (need a minimum of 2)*

% of Voting Rights*

Positions or Titles in a 508 Ministry at a minimum include: Managing Director (You) and Executive Director. Additional titles may include: Treasurer, Secretary, Assistant Managing Directors 1-3 etc., Please indicate corresponding title with each entry:

TITLE: Managing Director - enter your name and contact information here*

First

Last

Managing Director Address*

Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code

Managing Director Phone*

Managing Director Email*

Managing Director Voting Rights Percentage*

TITLE: Executive Director - enter your Executive Director's name and contact information here*

First

Last

Executive Director Address*

Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code

Executive Director Phone*

Executive Director Email*

Executive Director Voting Rights Percentage*

TITLE: Treasurer - enter your Treasurer's name and contact information here

First

Last

Treasurer Address:

Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code

Treasurer Phone

Treasurer Email

Treasurer Voting Rights Percentage

TITLE: Secretary - enter your Treasurer's name and contact information here

First

Last

Secretary Address:

Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code

Secretary Phone

Secretary Email

Secretary Voting Rights Percentage

TITLE: Assistant Managing Director 1 - enter your Treasurer's name and contact information here

First

Last

Assistant Managing Director 1 Address:

Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code

Assistant Managing Director 1 Phone

Assistant Managing Director 1 Email

Assistant Managing Director 1 Voting Rights Percentage

TITLE: Assistant Managing Director 2 - enter your Treasurer's name and contact information here

First

Last

Assistant Managing Director 2 Address:

Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code

Assistant Managing Director 2 Phone

Assistant Managing Director 2 Email

Assistant Managing Director 2 Voting Rights Percentage

TITLE: Assistant Managing Director 3 - enter your Treasurer's name and contact information here

First

Last

Assistant Managing Director 3 Address:

Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code

Assistant Managing Director 3 Phone

Assistant Managing Director 3 Email

Assistant Managing Director 3 Voting Rights Percentage

MAILING ADDRESS FOR MINISTRY (if different)

Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code

Please describe the purpose of the ministry:*

Are you or were you involved in a controversy with the IRS?*

Yes

No

If so when?

Please briefly describe:

This assists us in helping you remain in compliance to avoid taxes (by way of creating a compliant tax free entity) vs. evade taxes, the latter of which is unlawful and illegal. Holding the intent to be and remain in compliance and harmony with the United States is a necessary prerequisite for working with us. By contracting with us you agree to provide honest and accurate information to the best of your knowledge and ability on this form. A driver's license or government ID and a limited Power of Attorney (PoA) are also required for us to process this for you.

Upload a scan or photo of your driver's license or government ID here. We will securely delete/wipe this after we have verified your identity. *

How did you hear about us? *

Search Engine

Social Media

Personal Referral

other

Name of Personal Referral*

Word Verification