KGWN/KNEP Church/Business Closing Code Request

KGWN/KNEP Church/Business Closing Code Request
Name of Church, Business or Organization *
Location of Church, Business or Organization *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Primary Contact Name *

First Name Last Name
Primary Contact Phone Number *

Area Code Phone Number
Primary Contact Email Address *
example@example.com
Secondary Contact Name

First Name Last Name
Secondary Contact Phone Number

Area Code Phone Number
Secondary Contact Email Address
example@example.com
List of people authorized to close your Church, Business or Organization
Please enter your date of birth. *

Month Day Year
You must be 18 years of age to submit.
*
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I Agree to the Terms and Conditions
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