NON PROFIT General Intake Form
Nonprofit Setup & Filing Fee - $850 + IRS FEE made to IRS Directly
Name of Your Nonprofit Organization
Your Name/President
Address (no PO boxes)
City / State/ Zip
Phone#
Alternate Phone#
County
Email Address
example@example.com
EIN# or SS#
3-5 board members including yourself (not related or don't have same last name)
President (should be the CEO)
Board member#1
Board member#2
Board member#3
Board member#4
Board member#5
Mission Statement
Vision Statement
Purpose Statement
FOR CHURCHES "ONLY"
# of active members
# of active attendance
Days and times of service
Statement of Faith
Church Website address
Please provide a copy of your church bulletin
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Additional Information
Signature
Date
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Month
-
Day
Year
Date
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