Pastoral Discount Application
Pastor Name
*
First Name
Last Name
Church
*
Church Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Church Phone Number
*
Please enter a valid phone number.
Church Website
*
Pastor's Position/Title
*
Pastor's Email
*
Full-time?
*
Yes
No
Average Number of Hours Worked Per Week
*
Ordained?
*
Yes
No
Licensed?
*
Yes
No
Other Sources of Income
*
Please list the names of your students and their upcoming grade.
*
Additional Comments
Submit
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