Specials

NOTE: PRINT A COPY OF THIS ENROLLMENT FORM FOR YOUR RECORDS BEFORE SUBMITTING IT.

If this form is not functioning properly, Call (940) 464-3141

ENROLL IN THE CHURCH BUSINESS NETWORK AS AN

AGENT

Please describe your position in a Church or Christian Organization

	Pastor
	Associate Pastor
	Music Minister (Full-Time)
	Music Minister (Part-Time)
	Non-Profit Organization Director or Trustee
	Other (describe below:) Your position may not qualify you to become an Agent

Complete the Following Information about You and Your Church:
(ALL Fields MUST be completed to be a Agent):

Enrolling Agent	Type Name & ID # of CBN Agent enrolling you (if any)
Your Legal Name	Your Legal Name will be necessary to process payments & report your income on a MISC 1099
Church Name or Organization	For which you will be the listed Agent
Mailing Address
City
State	Example TX, not Texas
Zip Code
Phone Number (Primary Contact#)	Please type as Example: xxx-xxx-xxxx
Email Address	Add Me to Your "CBN Weekly ENewsletter" List
Church Website URL
Pay My Monthly Commissions: (Type Only. Do Not Enter Acct Numbers)	Type: By Check / PayPal Account / Other We will contact you personally to get this important, security-sensitive information, including SSN#
Name of Person who can Authorize Your Affiliation with Church or Org.	This is REQUIRED to become an Agent
Phone Number of Authorizing Person	This is REQUIRED to become an Agent

Additional Comments or Questions:

What 10 other Churches do you know that might benefit from services of CBN website?
The 10 churches you list (if not reserved by a previous Agent) will be reserved for you to sign-up for up to 30 days after you become an agent.

Check here if your church is going to become a Member (DO NOT List them in the churches below.)

Church 1 / City
Church 2 / City
Church 3 / City
Church 4 / City
Church 5 / City
Church 6 / City
Church 7 / City
Church 8 / City
Church 9 / City
Church 10 / City

COMPLETE ENROLLMENT BY CLICKING HERE: