Account Application

Church Account Application * Required Field
Church Information
*Church Name
*Tax Exempt Number
*Purchase Order Required  
Mailing Address
*Address
   
*City
*State  
*Zip
Shipping Address
*Address
   
*City
*State  
*Zip
 
*Email Address
*Phone
Key Contacts
*Name
*Title
*Address
 
*Phone
 
*Name
*Title
*Address
 
*Phone
 
*Name
*Title
*Address
 
*Phone
Banking References
*Bank Name
*Branch
*Address
   
*City
*State  
*Zip
 
*Bank Name
*Branch
*Address
   
*City
*State  
*Zip
Other Business References
*Name
*Account Number
*Phone
*Name  
*Account Number  
*Phone  
Credit Reference
Bank Card  
Account Number  
Expiration Date    
Bank Card  
Account Number  
Expiration Date    
Additional Information
*Conference, Synod, Diocese, etc.  

Submission of this form grants Cokesbury permission, if needed, to review the credit history of the person or company applying for a Cokesbury charge account

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