Donation – New England Pentecostal

Date *

Department Information

Department Name *

Person Requesting Funds

Title

Telephone #:

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Payee Name *

First

Last

Address

Address Line 1

City

State

Zip Code

Telephone #

Payment Due Date

Amount Requested *

Memo

Upload Invoice/Receipt (if available)

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No payments can be disbursed without proper invoices, receipts or authorization for reimbursements. (Please attach invoices or receipts to this request)

Name *

First

Last

Address

Address Line 1

City

State

Zip Code

Email *

Phone *

Dates Desired 1 (4th Sundays Only) *

Dates Desired 2 (4th Sundays Only)

Please check appropriate response:

Member

Related to a member

Child's Information

Child's Name as it appears on Birth Certificate (Please provide us with a copy)

Place of Birth

Child's Gender

Hospital

Date of Birth

Parent's Name

Godparent's Name

Upload Birth Certificate *

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IF YOU ARE NOT A MEMBER OR A RELATIVE OF A MEMBER HERE AT THE NEW ENGLAND PENTACOSTAL MINISTRIES, THEN THERE IS A PROCESS FEE OF $35.00.

Name *

First

Last

Address

Address Line 1

City

State

Zip Code

Tele/Cell (public) *

Names of Children

Email *

Birthday *

Did you hold a membership at a previous church?

Have you been called to the ministry?

Were you working in the ministry prior to coming here?

Do you desire to work in this ministry?

Date of class to attend

Signature

Clear Signature

Date

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OTHER DONATION METHOD

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Department Information

Check Distribution Information

Birth & Dedication Application

Child's Information

New England Pentecostal Ministries Membership Request Application

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