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 A

MEMBER CHURCH / ORG.

Please describe your position in a Church or Christian Organization

	Pastor
	Associate Pastor
	Music Minster
	Staff Member
	Non-Profit Organization Director or Trustee
	Other (describe below:)t

Complete the Following Information about and Your Church or Organization:
(ALL Fields MUST be completed to be a Member):

Enrolling Agent & ID	Name & ID # of CBN Agent enrolling You (if any)
Your Name	This name will be considered the Authorized Contact Person
Church Name or Organization	Must be a Legal, Non-Profit with the IRS to receive donations available thru CBN
Mailing Address
City
State
Zip Code	Example: TX, not Texas
Phone Number	Example: xxx-xxx-xxxx
Email Address	Add Me to Your "CBN Weekly ENewsletter" List
Church Website URL
Pay Our Quarterly Donation: (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 501-C-3#
Name of Person who will Authorize and Maintain Your relationship with CBN.	This is REQUIRED to become a Member
Phone Number of Authorizing Person

Additional Comments or Questions:

What are the TOP 10 Products or Services you would like to order from CBN website?
Depending on the services you list, we will attempt to sign-up Affiliates to meet these needs and let you know when those products or services become available on CBN. Until such time, complete the Purchase Order Request Form on CBN's Website.

Check here if your church will wait to order until PHASE 3: One Shopping Cart - One Bill

Product/Service
Product/Service
Product/Service
Product/Service
Product/Service
Product/Service
Product/Service
Product/Service
Product/Service
Product/Service

COMPLETE ENROLLMENT BY CLICKING HERE: