Nonprofit/Church application

Community Non-Profit/Church Application
Agency/Church Name*
Parent Organization
Address*
City*
State*
Postal Code*
Authorizing Officer*

First NameLast Name
Authorizing Officer Title*
Email*
example@example.com
Tax Exempt Number
Group Number
Persons authorized to use this account: (#1 Space for Primary) or upload your list below.
1
2
3
4
5
6
Attach a list of approved shoppers here if you have more than 6

Cancelof
IRS Letter of Determination/Church Bulletin*

Cancelof
Signed Non-Profit Agreement*

Cancelof
Signature*

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Date*

MonthDayYear
Date
Should be Empty: