csc - TechLed

csc #65

Church/House of Worship Information

Organization Name

Phone Number

Federal Tax ID Number (EIN):

Physical Address*

Street Address

City

ZIP Code

State

Company Email

Confirm Email

Sales Tax Exemption Status

Number of years in existence

Website

Pastor, Member, and/or Guarantor Information

How many owners/guarantors?

Principal #1

First Name

Last Name

Title

Home Address

Street Address

City

ZIP Code

Date of Birth

Email

State

Social Security Number

Phone/Mobile

Confirm Email

Principal #2

First Name

Last Name

Title

Home Address

Street Address

City

ZIP Code

Date of Birth

Email

State

Social Security Number

Phone/Mobile

Confirm Email

Principal #3

First Name

Last Name

Title

Home Address

Street Address

City

ZIP Code

Date of Birth

Email

State

Social Security Number

Phone/Mobile

Confirm Email

Principal #4

First Name

Last Name

Title

Home Address

Street Address

City

ZIP Code

Date of Birth

Email

State

Social Security Number

Phone/Mobile

Confirm Email

Equipment Information

What are you purchasing?

Equipment Type

Time Frame

Equipment Cost

Vendor

Declaration

I have read and agree to the Terms & Conditions

Consent: Terms & Conditions