Please provide all of the following information to receive a pre-qualification quote.

Church Name:
Present Mail Address:
City:
State:
Zip Code:
Telephone:
Fax Number:
Church Email:
Date of Incorporation:
Tax ID #:
Senior Pastor:
Pastor's Cell:
Evening Phone:
Average Weekly Attendance (Adults):
Average Weekly Attendance (Children):
Last year's Total Gross "Plate Income":
This year's expected "Plate Income":
Last year's net daycare income (if any):
Property debt: Debt on your present properties (if any)
Present monthly payment is:
Interest rate is: %
The purpose of this financing request is:
Total real estate value will be: Best guess (include planned inprovements)
The total amount of this church financing request is:
   

Submitting Agent/Originator Requesting "Pre-Qual" Quote

Company:
Phone:
Fax:
Agent Name:
Agent Cell:
Agent Email:

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