King of Kings Storm Assistance Application

King of Kings Storm Assistance

In the aftermath of the tornados in our region, King of Kings Church is accepting applications for assistance in paying insurance deductibles.
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*
Email*
example@example.com
How did you hear about King of Kings?

I am a King of Kings MemberI am a King of Kings VolunteerOther
Please provide a description of damage to your house.*
Type of Damage*
Insurance Claim Number*
Deductible Amount*
Insurance Company*
Please Attach the Following:
Proof of Insurance & Deductible*

Cancelof
Driver's License*

Cancelof
Limited funds are available, and funds will be distributed based on need.
Term & Conditions*

By submitting this I acknowledge that all information is correct
We will get back to you with an answer within a few days of receiving your application.
Should be Empty:

King of Kings Storm Assistance