2018 New Member Credentials Payment Form

New Member Credentials Payment Form

Monthly Auto-Pay
2021 Credentialing Fees:

$500/individual rate or $45 month

$700/Couple rate or $65 month

The monthly convenient payment option includes a monthly bank fee. Credentials are renewed each years-end and are based on a quarterly pro-rated amount on the month approved for credentials.
Full Name *

First Name Last Name
Ministry Title *
Cell Phone *

Area Code Phone Number
E-mail *
Spouse Name (if applicable)

First Name Last Name
Spouse Ministry Title (if applicable)
Spouse Cell Phone Number

Area Code Phone Number
Spouse Email
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Please Let us know which personal contact info you would like listed in The River directory. Please use my:
Church Address Home Address
Church Phone Cell Phone
Church Email Personal Email
Home Church / Ministry Associated with
Ministry Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Ministry Phone

Area Code Phone Number
Ministry Email
Ministry Website
Paying for Individual or Couple? *
Payments taken out on the 5th or 20th each month? *
Making payments using... *
Name of Business/Ministry:
Please use the area below to fill out your credit card information. Please use correct credit card billing information as many business/ministry credit card have different billing addresses than home address. Thank you.

Payment Options *

Individual Rate for members joining in January ( $ 45.00 for each month )

Couple Rate for members joining in January ( $ 65.00 for each month )