WVLT Church/Business Closing Code Request

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

Street Address

Street Address Line 2

CityState

Zip Code
County*
Primary Contact Name*

First NameLast Name
Primary Contact Phone Number*

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

First NameLast Name
Secondary Contact Phone Number

Area CodePhone 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.*

MonthDayYear
You must be 18 years of age to submit.
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